Morphological studies on the pathogenesis of Reinke's edema

Abstract

Light microscopy of vocal cord mucosa in patients with Reinke's edema revealed highly ramified fissured spaces in the subepithelial tissue that were generally lined with flat cells. The ultrastructure of the parietal cells resembled fibroblasts whose cytoplasmic extensions overlapped in two to three layers in some places. Cell contacts were not observed. Neither electron microscopy nor immunohistochemical testing with antibody against laminin demonstrated a basal membrane. It was possible to distinguish between light and dark cells in the specimens examined. The cytoplasm of the light cells contained intermediate filaments, mitochondria, lysosomes, coated vesicles, caveolae and broad cisternae of rough endoplasmic reticulum. The dark cells were more numerous and typically exhibited a well-developed endoplasmic reticulum and free ribosomes. The parietal cells showed no immunoreaction against human vascular endothelial cells. Immunohistochemical demonstration of mesenchymal intermediate filaments using antibody against vimentin yielded a positive reaction for some of the cells in the walls of the crevices and subepithelial tissue. It was also possible to demonstrate a few cells with monoclonal antibody against macrophages (KiM6). These findings contradict the concept of lymphatic distension in cases of Reinke's edema. Since the parietal cells seen resembled synoviocytes in their structure and immunohistochemical reactions, findings indicate that the hollow spaces of Reinke's edema develop like neobursae from mechanical strain.

Voice analysis of patients with diverse types of Reinke's edema and clinical use of electroglottographic measurements

“…In previous studies [1,11,12] it has been reported that Fx was either decreased or increased, but not to the normal value. The diverse results obtained in those tests were dependent on variations in the tests and in the examinee's phonation technique or posture.…”

“…Reinke's edema manifests as a diffuse polypoid edema in the superficial layer of the lamina propria due to fluid retention, fibrosis induced by chronic inflammation and infiltration of parietal cells [1,2]. Its pathological mechanism and etiology remain largely controversial and, in comparison with other vocal diseases, it has diverse clinical presentations.…”

The effect of surgical treatment on voice quality in Reinke’s edema: an evaluation with vocal performance questionnaire and acoustic voice analysis

“…This fluid accumulates in this region because of local impairment of lymphatic circulation or vascular congestion and stasis secondary to damage of the vessel walls. [1,2] Reinke's edema are more frequently seen in women and often causes a coarse voice and hoarseness. Among its etiological factors, smoking, alcohol consumption, misuse of voice, chronic laryngitis, laryngopharyngeal reflux, allergy, inadequate fluid intake and systemic diseases like hypthyroidism can be enumerated.…”

Inflammatory cell types in Reinke's edema

“…Tillman et al did not find any epithelial lesions except for light parakeratosis in a study with 60 patients. [11] In our study, we reported no epithelial lesion. In all of the cases, the main histological alteration in H&E stained sections was edema in the lamina propria of the vocal folds.…”