• Open Access

CD34-positive fibroblasts in Reinke's edema

Authors

  • Lucio Díaz-Flores MD,

    Corresponding author
    1. Department of Anatomy, Pathology, Histology, and Radiology , Faculty of Medicine, University of La Laguna, Tenerife, Spain
    • Send correspondence to Lucio Díaz-Flores, MD, University of La Laguna, Faculty of Medicine, Department of Anatomy, Pathology, Histology, and Radiology, Ofra-La Cuesta, s/n, La Laguna, 38071 Tenerife, Canary Islands, Spain. E-mail: kayto54@gmail.com

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  • Ricardo Gutiérrez MD,

    1. Department of Anatomy, Pathology, Histology, and Radiology , Faculty of Medicine, University of La Laguna, Tenerife, Spain
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  • María del Pino García MD,

    1. Department of Pathology, Hospiten Hospitals, Tenerife, Spain
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  • Hugo Álvarez-Argüelles MD,

    1. Department of Anatomy, Pathology, Histology, and Radiology , Faculty of Medicine, University of La Laguna, Tenerife, Spain
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  • Lucio Díaz-Flores Jr. MD,

    1. Department of Anatomy, Pathology, Histology, and Radiology , Faculty of Medicine, University of La Laguna, Tenerife, Spain
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  • Daniel López-Campos MD

    1. Department of Otolaryngology, Faculty of Medicine, University of La Laguna, Tenerife, Spain.
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

To elucidate whether and to what extent CD34+ fibroblasts (so-called CD34+ fibrocytes, CD34+ dendritic cells, and CD34+ stromal cells) occur in normal human vocal folds and in Reinke's edema.

Study Design

Histological study.

Methods

Conventional, immunohistochemical, and ultrastructural procedures were performed in histological blocks of 18 selected cases of Reinke's edema (with typical findings including acellular edematous spaces in the subepithelial connective tissue of vocal folds, and disarrangement of elastic, collagen, and reticular fibers). For control purposes, four normal vocal folds were analyzed.

Results

In normal vocal folds, most stromal cells were spindle-shaped CD34+ fibroblasts. In Reinke's edema, increased density and changes in the morphology and size of this subpopulation of fibroblasts were demonstrated in the connective tissue surrounding the edematous spaces, particularly in their borders, where together with some macrophages they formed boundaries, mimicking the walls of distended lymphatic vessels when conventional stains were used. These activated CD34+ fibroblasts acquired a dendritic morphology (with long, moniliform, often bifurcated, overlapping multipolar processes), and their cytoplasmic organelles were increased in number. In addition to CD34, they expressed vimentin, CD10 and CD99, but no α-smooth muscle actin (α-SMA), CD31, CD117, CD68, h-caldesmon, desmin, or S-100 protein.

Conclusions

CD34+ fibroblasts are a major cell component in the stroma of vocal folds in Reinke's edema, and their activation, with increased density and morphologic changes around the edematous spaces, occurs without immunophenotypic transformation toward myofibroblasts (no expression of α-SMA). The mechanisms by which these cells act in Reinke's edema require further study.

Level of Evidence

NA Laryngoscope, 124:E73–E80, 2014

Ancillary