Answer: Teflon granuloma

Histology: Irregularly shaped refractile bodies are cuffed by foreign body giant cells and surrounded by dense fibrous tissue. Under cross-polarized light, the particles are strongly birefringent.

Discussion: Teflon granulomas are encountered in patients who have undergone injection of tetrafluorethylene or polytef (teflon) into the vocal fold for the purpose of augmenting a paralyzed vocal cord. Dysphonia is usually the result of overinjection, an exuberant granulomatous reaction to the teflon, or a misdirected injection. When the injection is misdirected, the Teflon may migrate laterally or anteriorly and present as a firm nodule in the neck or thyroid respectively. Although a teflon granuloma may mimic a neoplasm clinically, they are not so easily mistaken at the histologic level. The polytef fragments elicit a foreign-body giant cell reaction, and they are strongly birefringent under cross-polarized light.