Laryngeal polyp associated with reflux disease: an uncommon presentation
Dr Wael Abdo Hassan at the Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt has reported a rare case of Laryngeal polyp associated with reflux disease. The case has appeared in the Journal of Medical Case Reports.
A laryngeal polyp is one of the most common benign laryngeal lesions and their aetiology is related to vocal abuse. Gastroesophageal reflux disease is a common condition presenting with a broad spectrum of symptoms, among which are extraesophageal manifestations such as laryngeal polyps.
A 24-year-old Middle Eastern woman presented to the author's ear, nose, and throat (ENT) clinic with a complaint of the dysphonia that had been present for 2 months. The patient gave no history of any intubations, trauma, or voice abuse. She had associated dyspeptic symptoms. On examination of the ear, nose, and throat, a polypoid lesion was present on the middle one-third region of the left vocal cord measuring approximately 4 × 3 cm in diameter. The patient was referred to the gastroenterology clinic to undergo endoscopy. She was diagnosed with grade C GERD on the basis of the Los Angeles classification system of GERD. Returning to the ENT clinic, the patient was scheduled for surgery for removal of the laryngeal polyp. With the patient under general anaesthesia, the polypoid lesion was excised completely by suspension direct laryngoscopy, with no residual tissue left behind.
The excised polyp was fixed in 10% formalin and embedded in paraffin. Serial sections, 5 μm thick, were processed for hematoxylin and eosin (H&E) staining. Immunohistochemistry (IHC) staining was carried out with the streptavidin-biotin method. Primary antibodies (Additional file 1: Table S1) were purchased from Genemed Biotechnologies (San Francisco, CA, USA).
On gross pathological examination, the specimen consisted of a polypoid mass measuring 4 × 3 cm with a smooth outer surface and a congested cut section. Histologically, as observed by H&E) staining, the polyp was lined with thickened, nonkeratinized, stratified, squamous epithelial covering with disruption of superficial layers of epithelium causing small blisters with intraepidermal microabscesses and underlying areas of haemorrhage. The basal epithelial cells were thickened with elongation of rete ridges and mild atypical changes involving the lower third of the epithelial covering in the form of enlarged hyperchromatic nuclei and mild disturbed polarity. The underlying stroma showed numerous proliferated blood vessels, with some of them dilated with congestion and others with thrombi. Nests of uniform stratified squamous epithelium were present within the stroma and surrounded with basement membrane, representing pseudoepitheliomatous hyperplasia. Dense fibrous tissue deposition was present in the stroma, with focal areas of edema and chronic inflammatory cell infiltrate and numerous focal accumulations of clear cells with enlarged nuclei. Focal separation of overlying epithelial covering by edema was seen. Focal ulceration with underlying granulation tissue-like reaction was also observed.
By IHC staining, a negative reaction to p53 in the overlying epithelium was detected, thus excluding the possibility of epithelial dysplasia. In addition, E-cadherin expression was decreased in the superficial layers of the squamous epithelial covering, leading to intercellular spongiosis and the accumulation of neutrophils with microabscess formation. The accumulated clear cells stained positive for CD68 and negative for pan-cytokeratin, confirming their nature as foamy macrophages.
Journal Information: Journal of Medical Case Reports
For more details click on the link: https://doi.org/10.1186/s13256-019-2324-0