Answer: Vocal cord polyp, traumatic type

Histology: The surface epithelium is ulcerated. The underlying subepithelial tissues shows prominent edema and fibrin deposition forming a polypoid mass. The fibrin deposits around submucosal vessels giving rise to dense pink perivascular collars.

Discussion: Although the terms vocal cord nodule and vocal cord polyp are often used synonymously, they do have some distinguishing features clinically and histopathologically. Vocal cord nodules are clinically seen as fusiform swelling of the anterior vocal cords bilaterally in response to chronic voice abuse. Therapy tends to be conservative, and they may entirely disappear with voice rehabilitation without the need for surgery. Histopathologically, a true vocal cord nodule demonstrates hyperplasia of the submucosal fibroelastic tissue in the absence of significant stroma edema, inflammation and fibrin deposition.

Vocal cord polyps, on the other hand, are seen clinically as polypoid masses that protrude into the endolarynx, often attached to the vocal cord on a stalk. They are much more apt to be unilateral lesions. They arise in association with acute and chronic forms of injury ranging from screaming to habitual smoking. The present case is an example of an acute hemorrhagic vocal cord polyp following an acute traumatic event (e.g. overzealous yelling). The acute hemorrhage has largely resolved, and the prominent histologic feature is fibrin deposition. It is quite characteristic for the fibrin to condense around ecstatic blood vessels, a finding that is often misinterpreted as amyloid deposition. This eosinophilic stromal material is Congo Red negative. Vocal cord polyps lack the prominent granulation tissue and inflammation of contact ulcers which typically occur along the posterior aspect of the vocal cords.