Benign Tumefactive Pathology of Voice: Does Anybody Really Know What Kind It Is?
NA Cipriani, D Martin, J Corey, L Portugal, N Caballero, R Bleck, R Kunnavakkam, B Anthony, JB Taxy. The University of Chicago, Chicago
Background: Benign lesions of the vocal cord (VC) primarily related to vocal abuse, reflux and smoking are clinically classified as: 1) polyps (P) (uni or bilateral, exophytic or sessile, anterior VC); 2) nodules (N) (symmetric swellings, anterior-mid VC); 3) Reinke's edema (RE) (uni or bilateral swellings of the entire VC); 4) cysts (C) (discrete unilateral swellings with epithelial lining). Histologic examination of all lesions except cysts has shown similar and variable presence of edema, vascular proliferation, extracellular fibrin ("amyloid-like"), basement membrane thickening & epithelial hyperplasia. Treatment varies: N and RE are initially treated conservatively, while P and C are excised surgically. There is a a lack of consensus among clinicians & pathologists regarding the classification of these lesions, and there exist no universal histologic criteria. This study aims to elucidate the clinicopathologic correlation, or lack thereof, among these benign lesions of the VC.
Design: A 20 year retrospective search of the UCMC surgical pathology database for all such benign lesions of the VC yielded 78 cases. They were reviewed by one pathologist for the above 5 histologic parameters and classified as P, N, RE, C or other. Of these, 41 also had endoscopic & stroboscopic images reviewed and classified separately by 2 otolaryngologists.
Results: Among the 41 cases reviewed clinically and histologically: All 3 agreed in 25% of cases, mostly P. None agreed in 17%. One clinician and pathologist agreed in 43%. The pathologist disagreed with the diagnosis of both clinicians in 15%. The overall kappa statistic was 0.17 (0.08-0.24, 95% confidence interval). Histology in all cases showed a range of epithelial hyperplasia, basement membrane thickening, edema, vascular proliferation, and fibrin/amyloid-like material. There were no histologic features that reliably distinguished among P, N or RE. C were all epithelial-lined. Stromal cell atypia was isolated. No suspicion of malignancy was identified.
Conclusions: Indefinite clinical and histologic criteria in these benign VC lesions may explain the poor agreement between the 2 clinicians and the poor clinicopathologic correlation. Only true cysts, having a lining, are histologically distinct. While treatment may be individualized per clinical judgement, the classification of a lesion as P, N or RE is neither clinically reproducible nor histologically unique.
Category: Head & Neck
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 162, Tuesday Afternoon