Analysis of a polytef granuloma mimicking a cold thyroid nodule 17 months after laryngeal injection

A 65-year-old female who received laryngeal injections with polytef (Teflon) paste for treatment of right vocal cord paralysis first noticed a small, right anterior neck mass 17 months later. Clinically this mass slowly progressed in size and was felt to be a recurrent carotid body tumor, but at surgery, 22 months after injection, a circumscribed nodule on the anterior right lobe of the thyroid was found and histologically diagnosed as a foreign body granuloma. Scanning electron microscopy (SEM) and energy-dispersive x-ray analysis (EDXA) of material in this lesion was identical to that of polytef paste, which is a mixture of pyrolyzed polytetrafluoroethylene and glycerine. The possibility that deaggregated smaller particles in the polytef paste were able to migrate from the injection site resulting in this neck mass is considered.