Hemorrhagic Pseudocyst (Polyst) and True Hemorrhagic Cyst of the Vocal Fold

Abstract

ObjectiveThough haemorrhagic vocal fold polyps are a common entity, haemorrhagic vocal fold cysts have not been previously described. In our study we have evaluated patients who were diagnosed on stroboscopy as “haemorrhagic” cysts. MethodsThis 18-month retrospective study has received institutional ethics clearance. Using the database of our voice clinic, 14 patients diagnosed as haemorrhagic cyst by stroboscopy were reviewed. Age, sex, chief complaints, symptom duration, videostroboscopy findings, surgical details and the histopathology was noted. ResultsOut of a total 14 patients, 12 were males with a mean age of presentation as 41 years. Duration of hoarseness ranged from 2 - 24 months. Videostroboscopy revealed a markedly decreased amplitude of the mucosal waves over a well-delineated ovoid or spheroid haemorrhagic lesion, which seemed tethered down by overlying vocal fold epithelium. All patients had operative findings of a well encapsulated haemorrhagic lesion in the superficial lamina propria with anterior and posterior fibrotic bands. Histopathology of 13 patients was similar and revealed a haemorrhagic polypoidal lesion. A pseudo-capsule could be identified occasionally. These lesions seemed to be haemorrhagic pseudocysts, named “polyst” by us. In one male patient the histopathology revealed a true vocal fold cyst (type C Koren) with haemorrhage. ConclusionA haemorrhagic pseudocyst (polyst) of the vocal fold has stroboscopic and surgical findings resembling a true vocal fold cyst with haemorrhage, however histologically it resembles a haemorrhagic polyp. A true haemorrhagic cyst however is typically a type C Koren cyst with haemorrhage. Both these entities have not been previously described.