Exudative laryngeal diseases of Reinke's space: A clinicohistopathological framing

Objective: To establish the relationship between the macroscopic and histologic diagnosis of nodules, polyps, and Reinke's edema of the true vocal folds and to propose a clearer clinical definition of them in the hope of settling the difference of opinion between otolaryngologists and pathologists. Design: Retrospective study. Setting: Otolaryngology Department of "La Sapienza" University of Rome. Methods: T he pathologic reports of 203 patients subjected to direct laryngoscopy were studied. Main Outcome Measures: Examination of the histologic specimen of the epithelium and the chorion. Results: Microscopic examination revealed a high percentage of normal epithelium both for nodules (33.79%) and polyps (40.65%). No dysplasia was observed, whereas dysplasia was present in 10 cases of Reinke's edema (7 laryngeal intraepithelial neoplasia 1 and 3 laryngeal intraepithelial neoplasia 11). Five different stages of histologic progression resulted from the examination of the chorion in both nodules and polyps. Conclusions: Our suggestion is to consider polyps as "older" lesions and nodules as "younger" lesions. A polyp may be defined as an abnormal unilateral growth of vocal folds, a nodule as a bilateral growth situated between the anterior and medium third of the vocal fold, and Reinke's edema as a bilateral wound that extends to the whole of the true vocal fold.