Cartilage tumors of the larynx

Laryngeal chondrosarcoma, a 30-year series

INTRODUCTION AND OBJECTIVES

Laryngeal chondrosarcoma is a rare laryngeal pathology arising from cartilaginous structures and is predominantly found in the cricoid cartilage. This study investigates its presentation, treatment modalities and patient outcomes.

PATIENTS OR MATERIALS AND METHODS

Retrospective study of laryngeal chondrosarcoma cases followed from 1992 to 2022 in the Otorhinolaryngology department of a cancer center - Instituto Português de Oncologia de Lisboa. Statistical analysis was made with Microsoft Excel® and SPSS®.

RESULTS

We identified 16 cases, of which two-thirds were male, with an average age of 59.6 years, and only 24% of them had a history of smoking. The commonest presentation was indolent dysphonia and/or dyspnea, and the posterior arch of the cricoid cartilage was the most affected place. Although histopathological studies after biopsy were often inconclusive, surgery emerged as the first-line of treatment for all patients. Larynx microsurgery with lesion debulking was the most frequent surgical approach (47%) followed by partial laryngectomy (24%). Neither adjuvant radiotherapy (RT) nor chemotherapy was administered in any of the cases. There was residual tumor in 23% of the cases so half of these patients were in watchful waiting while the other part underwent further microsurgery or total laryngectomy. Only one patient with recurrence received RT. Disease-specific survival rate at 1 and 5 years was 97% and 91%, respectively.

CONCLUSION

Laryngeal chondrosarcoma etiology is still unknown and is effectively treated with surgery, with a generally favorable prognosis. The main concern lies in its propensity to relapse, highlighting the importance of watchful follow-up.

Chondrosarcoma of the Thyroid Cartilage Successfully Treated With Partial Resection of the Thyroid Cartilage

Chondrosarcoma of the thyroid cartilage is a sporadic disease with nonspecific clinical presentation. Smooth swelling of the supraglottic area should arouse suspicion of possible pathology. In addition to laryngoceles, which usually do not have a significant impact, otolaryngologists should consider chondrosarcoma of the thyroid cartilage and indicate computed tomography (CT). Late diagnosis leads to worse prognosis, particularly worse voice after more extensive surgery, need for tracheostomy, and worse survival from higher degree chondrosarcomas.

Chondrosarcoma of the thyroid cartilage: surgical management of a rare case

Laryngeal malignancy encompasses about 1% of all cancers. Chondrosarcoma in the head and neck region represents about 0.1% of head and neck malignancies. Typical presenting symptoms relate to the anatomical location of these tumours and include dysphonia, inspiratory stridor, dysphagia, odynophagia or a neck mass. Benign and malignant cartilaginous cancers of the larynx have been described, and preoperative diagnosis can be difficult. Our report highlights the surgical management of a male patient in his 50s with chondrosarcoma of the thyroid cartilage.

Chondrosarcoma of the Larynx: Presentation of a Case and Review of the Literature

Chondrosarcoma of the larynx is a rare tumor of the upper respiratory tract that originates from cartilaginous tissue. The cricoid cartilage is the most frequent site of onset at the larynx. The diagnosis is not always easy, given the tumor's slow growth rate, the aspecificity of the symptoms, and the low degree of malignancy with which most cases present and which often causes it to be mistaken for a chondroma. A case is presented of a 61-year-old woman with a chondrosarcoma of the larynx, grade 2, originating from the cricoid cartilage and measuring about 3 cm in diameter. The patient underwent extirpation of the tumor together with the cricoid cartilage, with a successive thyrotracheal anastomosis because she refused a total laryngectomy, which would have been the indicated intervention on the basis of the extent and grade of the neoplasm. At 6 years from surgery, the patient is in a good state of health with good laryngeal function and without recurrence of the disease. This fact confirms that the surgical approach to chondrosarcoma of the larynx can in most cases be conservative, reserving demolitive surgery for the more aggressive forms, for tumors of greater extent, and for recurrences. In fact, good laryngeal function and therefore a good quality of life can be maintained even for long periods of time.

Laryngeal chondrosarcoma: A systematic review of 592 cases

OBJECTIVES/HYPOTHESIS

Laryngeal chondrosarcomas are rare entities that arise from the cartilaginous structures of the larynx, including the cricoid, thyroid cartilage, epiglottis, and arytenoid cartilages. These tumors represent a minority of malignancies involving the larynx and can be mistaken for benign pathologies. The treatment has historically been surgical excision, often by total laryngectomy. This review investigates treatment modalities and patient outcomes.

STUDY DESIGN

Systematic review using PubMed/MEDLINE and EMBASE database.

METHODS

The databases were used to identify articles reporting cases of chondrosarcomas occurring exclusively in the larynx. Variables analyzed included patient demographics, presenting symptoms, grade, therapeutic approach, patient outcomes, and follow-up.

RESULTS

Five hundred and ninety-two cases were identified. The average age reported was 62.5 years. There was a 3:1 male to female ratio. The most common surgical approach was local excision in 178 cases, followed by total laryngectomy in 174 cases. Nonsurgical treatment such as radiotherapy and chemotherapy was only used in 0.8% and 0.2%, respectively. Disease-specific survival rates for 1, 5, 10, and 20 years were 97.7%, 91.4%, 81.8%, and 68.0%, respectively, with no differences when comparing 5-year survival rates for location, grade, and therapy.

CONCLUSION

Laryngeal chondrosarcomas are rare with a good prognosis. Various surgical approaches exist, with no difference noted in 5-year survival outcomes. Nonsurgical approaches were rarely used for these lesions.

LEVEL OF EVIDENCE

N/A. Laryngoscope, 2016 127:430-439, 2017.

Laryngeal chondroma: a rare diagnosis in this localization

Primary chondroid tumors of the larynx represent less than 1% of all laryngeal tumors. Most of them are chondromas and they often involve to the cricoid cartilage. A 31-year-old male patient applied to the oto-laryngology service with a history of dysphonia and dyspnea. Microlaryngoscopy revealed 2 cm sized, ill-defined, covered with regular mucosa, porous, and hard mass on posterior surface of crycoid cartilage in subglottic area. Following the excision of the lesion, histopathologic examination revealed as chondroma. Two years later, local recurrence was detected and the diagnosis was again chondroma. There was no complaint of the patient in last 3 and half years of follow-up. Chondroma should carefully be differentiated from chondrosarcoma and the patients should be followed for possible recurrences.

Hemicricoidectomy as the primary diagnosis and treatment for cricoid chondrosarcomas

OBJECTIVES/HYPOTHESIS

The objective was to present a new approach for the diagnosis and treatment of chondrosarcoma involving the cricoid cartilage. The technique involved an extramucosal resection of the ipsilateral half of the involved cricoid cartilage, providing enough tissue to be sent for pathological study, and resulted in good laryngeal function without jeopardizing patients' long-term survival.

STUDY DESIGN

Retrospective study.

METHODS

A retrospective study of eight patients who underwent hemicricoidectomy for cricoid chondrosarcoma was performed at the Center for Voice Disorders, Wake Forest University (Winston-Salem, NC). One patient was a woman and seven were men. The mean age at diagnosis was 64 years (age range, 53-72 y).

RESULTS

All patients had a low-grade tumor. Primary treatment included hemicricoidectomy in all cases. In six (75%) of the patients, tracheotomy was required at the initial surgery. The mean time for decannulation was 3.2 months (range, 5 d-1 y). In four cases a second procedure was required because of recurrence. The second procedure included two total laryngectomies and two endoscopic carbon dioxide laser excisions. The mean follow-up time was 3 years (range, 2 mo-10 y). At the time of writing, six patients were alive without recurrence, one patient was alive with disease; and one patient had died of unrelated causes.

CONCLUSION

The authors recommended unilateral hemicricoidectomy as the diagnosis and treatment of choice. This procedure allows sufficient tissue for histological study and provides good long-term breathing and phonatory function without compromising long-term survival. This procedure is appropriate for patients with 1) mobility of one vocal fold, 2) dysphonia or aphonia, and 3) an adequate subglottic airway.

First report of intralaminar tumorlike lipomatous lesions of the thyroid cartilage

INTRODUCTION

We present two cases of tumorlike lipomatous lesions in the thyroid cartilage. Both presented as circumscribed tumors by ultrasonography and were identified accidentally.

METHODS

Two tumorlike lesions were identified in two different patients. Additionally, computed tomography and magnetic resonance imaging scans of the laryngeal skeleton were performed. Surgery was performed in one patient, and the lesion was excised. Histopathology revealed fatty tissue with several foci of hematopoietic cells.

CONCLUSION

This is the first report of intralaminar tumorlike lipomatous lesions in the thyroid cartilage. These should be included in the differential diagnoses of primary cartilaginous lesions of the laryngeal skeleton.

[Chondroma of the larynx]

Chondroid tumors of the larynx are extremely rare and their develope and symptoms are difficult to diagnosis. The importance of well radiological diagnosis prior chirurgical treatment of chondroid tumors of the larynx is empasised. Conservative surgical management when possible, is advocated to preserve the larynx. We presented a case of chondroma of cricoid cartilage developing in 49-year old woman with 4 year history of hoarsness, treated by surgical management - laryngofissure. During 36 months follow up no reccurency is observed. In the paper review of literarature is presented.

Chondroid tumors of the larynx: A clinicopathologic study of 19 cases, including two dedifferentiated chondrosarcomas

We studied 19 cases of chondroid tumors of the larynx: two chondrometaplastic nodules, two chondromas and 15 chondrosarcomas (including two dedifferentiated chondrosarcomas). One of chondromas recurred 18 months after resection because of inadequate surgical treatment. Chondrosarcomas were separated as low-grade (nine cases), intermediate (three cases), high-grade (one case), and dedifferentiated (two cases) according to histologic appearance. Chondrosarcomas are nearly always histologically low grade, make up the largest numbers of the neoplasms, and arise from the cricoid cartilage. Conservative surgical management, when possible, is advocated to preserve the larynx. Chondrometaplastic nodules are to be distinguished from chondrosarcoma and the rarely occurring chondroma. The nodules are not neoplastic and have a low to nil recurrent potential.

Chondroma and chondrosarcoma of the larynx

PURPOSE OF REVIEW

The purpose of this review is to give a detailed description of chondroma and chondrosarcoma of the larynx and to put into perspective new findings from recent literature.

RECENT FINDINGS

Recent findings indicate that chondroma and chondrosarcoma of the larynx are closely related, either synchronously (areas of both tumor types within the same lesion) or metachronously (malignant transformation of chondroma over time). It is questioned whether the grading of Lichtenstein and Jaffe, and Evans et al. should be used in the larynx, because these grading systems were designed for chondrosarcoma of the long bones. Chondrosarcomas of the larynx seems to behave more like chondrosarcomas of the phalanx, because they too hardly ever metastasize or cause tumor-related deaths. Both CT and MRI play an important role in the workup of these tumors, but they cannot be used to differentiate between both tumor types. No new treatment modalities have emerged recently and surgery is still the treatment of choice. Tracheal autotransplantation may play an increasing role in the treatment of cricoid tumors because it allows for wide resection and optimal revalidation.

SUMMARY

It is now firmly established that metastasis in chondrosarcoma is a poor prognostic sign, but is very rare. Without metastasis the prognosis is excellent. Cartilaginous tumors of the larynx are rare. Clinical, radiologic and pathologic characteristics of these tumors are described and a review of treatment modalities is presented. Wide excision with clear margins is usually indicated. The authors recommend that the management of cartilaginous tumors of the larynx be multidisciplinary and centralized in dedicated referral centers.

Laryngeal chondroma presenting as an external neck mass

Laryngeal chondromas are rare benign tumors originating from the cartilagenous framework of the larynx. Since its first description in 1882, about 250 cases have been reported in the literature. Depending on the size of the lesion, excision via an endoscopic or open surgical approach is the treatment of choice. The majority of these patients present with an endolaryngeal mass. To encounter an external neck mass as the reason for the initial presentation is a rare occurrence. In this article we report a case of laryngeal chondroma of cricoid cartilage origin, which presented as a neck mass. The lesion was totally excised using a transcervical approach. No tracheotomy or laryngeal stent was needed postoperatively. Despite its rarity, this diagnostic possibility should always be kept in mind for elderly patients with complaints of progressive voice changes and exertional dyspnea.

Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature

Chondrosarcomas of the larynx are rare tumors accounting for about 0.5% of all laryngeal primary tumors. A total of 111 laryngeal chondrosarcoma cases, diagnosed between 1970 and 1997, were retrieved from the Otorhinolaryngic-Head & Neck Tumor Registry of the Armed Forces Institute of Pathology. There was a 3.6:1 male/female ratio of patients 25-91 years of age (mean, 64.4 years). Patients presented most frequently with hoarseness (n = 72 patients) present for a mean of 28.2 months. The majority of tumors involved the cricoid cartilage (n = 77) with a mean size of 3.5 cm. All tumors were invasive and malignant by radiology and/or histology (into bone within the ossified laryngeal cartilages in 52 tumors). Most tumors were low-grade lesions: grade 1 (n = 51), grade 2 (n = 54); there were six grade 3 tumors. An associated benign chondroma with (n = 41 tumors) or without ischemia (n = 24 tumors) was noted. All patients had surgery and five had radiation therapy. Wide excision or voice-sparing surgery was used in 73 patients, whereas 37 patients had a laryngectomy. Recurrences occurred in 20 (18%) patients, 10 of whom underwent salvage laryngectomy. At the last follow-up, 102 patients had no evidence of disease (alive or dead, mean 11.2 years) and five patients had evidence of disease (alive, one patient, 6.5 years; dead, four patients, mean 6.4 years). The six patients with high-grade chondrosarcoma were all without disease at the last follow-up (mean, 15.1 years). There was no difference in clinical outcome based on grade (p = 0.210), location (p = 0.078), or treatment (p = 0.607) but was worse for patients with a myxoid-type chondrosarcoma (p = 0.044). Primary laryngeal chondrosarcomas are typically low- to moderate-grade lesions involving the cricoid cartilage, frequently associated with a chondroma. They usually portend an excellent overall long-term prognosis with initial conservative voice-sparing surgery.

Chondrosarcoma of the Larynx: A Therapeutic Challenge

The diagnosis of laryngeal chondrosarcoma is likely to be missed because of its infrequent occurrence and its indolent pattern of growth. A 53-year-old woman came to our service with an 18-year history of hoarseness and increasing dyspnea. She had been previously documented as having left vocal fold paralysis and a bulging laryngeal mass. Computed tomography revealed the presence of a large calcified tumor that had caused a deformity of the larynx and an erosion of the arytenoid and cricoid cartilages. Direct laryngoscopy detected a large supraglottic mass with a normal-appearing mucosa. Total excision of the tumor was achieved through a lateral neck incision that spared the larynx. This case emphasizes the importance of a high index of suspicion for laryngeal chondrosarcoma in a patient who has unexplained vocal fold paralysis and a submucosal subglottic mass. Every effort should be made to take a conservative surgical approach that preserves laryngeal function when possible.

Osteoma of the thyroid cartilage--an unusual cause of difficult intubation

We describe a case of histologically proven osteoma of the thyroid cartilage that presented because of difficulty in intubation prior to coronary bypass surgery. To our knowledge, this is the first documented case in the English literature.

Fine-needle aspiration of dedifferentiated chondrosarcoma of the larynx

We present a case of dedifferentiated chondrosarcoma of the larynx in which the dedifferentiated component was initially diagnosed by fine-needle aspiration (FNA). The patient was a 74-yr-old man who presented with difficulty breathing and an anterior neck mass. A CT scan demonstrated a 4.5-cm cartilaginous lesion involving the left thyroid cartilage, with an anterior soft-tissue component. Nine years prior, the patient had an incomplete resection of a low-grade chondrosarcoma at the same site. FNA was performed on the current lesion, demonstrating a high-grade spindle-cell sarcoma with a storiform pattern. The cytomorphology together with immunocytochemistry and electron microscopy were diagnostic of malignant fibrous histiocytoma (MFH), and synthesis of the clinical, radiographic, and cytomorphologic features resulted in a diagnosis of dedifferentiated chondrosarcoma. The cytologic diagnosis was histologically confirmed by laryngectomy. Although rare, dedifferentiated chondrosarcoma should be included in the differential diagnosis of high-grade sarcomas of bone and cartilage assessed by FNA.

A case of giant chondrosarcoma of the cricoid cartilage presenting as a superior mediastinal tumour

We report the case of a 73-year-old man operated on for a symptomatic superior mediastinal mass which developed from the cricoid cartilage. Through cervicotomy and partial sternotomy, laryngeal subglottic resection allowed complete removal of the tumour. From pathological examination, a benign chondroma was initially diagnosed without any criterion of malignancy. However, subsequent review of the pathological slides showed the lesion to be a low grade chondrosarcoma with an epithelial quota of spindle cells, responsible for the patient's death. This case illustrates the need for resection of presumed cricoid cartilage chondromas because of their potential mediastinal development and associated malignancies.

Chondrosarcoma of the larynx: the role of radiotherapy revisited--a case report and review of the literature

BACKGROUND

Experience in the treatment of laryngeal chondrosarcoma is based on about 250 cases reported to date. The standard therapy is conservative surgery. Radiotherapy has universally been regarded as ineffective in the treatment of this disease.

METHODS

A patient with a laryngeal chondrosarcoma was observed for 11 years after radical radiotherapy. The literature on laryngeal chondrosarcoma was critically reviewed, with emphasis placed on radiotherapy.

RESULTS

The review of the literature revealed that experience with radiotherapy of laryngeal chondrosarcoma has been lacking, with fewer than 10 cases with short follow-up documented up to now. Meanwhile, increasing evidence of the efficacy of radiotherapy in the treatment of skeletal chondrosarcoma has emerged. The authors report the first case of chondrosarcoma of the larynx in which radical radiotherapy resulted in a long term remission of more than 10 years.

CONCLUSIONS

Radiotherapy should be considered when radical surgery is not feasible without severe mutilation. It should also be considered for the treatment of residual disease. Laryngectomy should be restricted to salvage treatment when radiotherapy fails. In this study, radiotherapy appeared to be an effective modality in the treatment of low grade laryngeal chondrosarcoma, and these results contrast with the current widespread disapproval of this treatment.

Cartilaginous tumors of the larynx: clinicopathologic review of 47 cases

We reviewed the clinical and pathologic features of 47 laryngeal cartilaginous tumors treated at the Mayo Clinic. This represents the largest reported series of these tumors. The patient group consisted of 36 men (77%) and 11 women (mean age, 63 years; range, 44 to 91 years). The tumors included 44 chondrosarcomas, all low-grade, and 3 chondromas. The overall 5-year survival was 90.1%, which did not differ significantly from the expected survival. Laryngectomy was performed as primary treatment for chondrosarcoma in 6 patients. Of the patients with chondrosarcoma, 40% had tumor recurrence or symptomatic tumor progression at an average of 4.5 years after diagnosis. Only 15 of the patients with chondrosarcoma (34%) required total laryngectomy. There were no metastases, and 4 patients died of local disease (all received treatment before 1960). At latest follow-up, 34 patients with chondrosarcoma (77%) were alive without disease or had died of other causes. We conclude that laryngeal chondrosarcoma can be treated with conservative surgery in most cases, both initially and for recurrent disease.

Laryngeal Chondroma: A Benign Process with Long-Term Clinical Implications

Chondroma of the laryngeal cartilage is a rare, benign neoplasm which can manifest as a neck mass or, if situated within the airway, as slowly progressive obstruction, hoarseness or dyspnea. The most common location for chondroma is the posterior lamina of the cricoid cartilage; the next most common locations are the thyroid, arytenoid and epiglottic cartilages. Chondroma and low-grade chondrosarcoma are difficult to distinguish from one another histologically. Although chondrosarcoma reportedly recurs, local surgical excision without radical margins and with long-term clinical follow-up is recommended. We report one case of thyroid cartilage chondroma and include a review of radiologic studies and histopathologic analysis results. We also report a second case with severe airway obstruction caused by a large cricoid chondroma. A review of the English language biomedical literature on laryngeal chondroma is included.

Laryngeal chondrosarcoma: two unusual cases

Although CS is the most common mesenchymal tumor of the larynx, there have only been approximately 200 cases reported to date. The nature, diagnosis, and management of these tumors are discussed. Although conservative therapy is acceptable in most instances, total laryngectomy may be opted for in cases of extensive tumor, high-grade lesions, and recurrences. CO2 laser excision for palliation has been shown to be a viable alternative in patients with high-operative risk. It is also shown that the behavior of these tumors is predictable, though not without some variation. Although these tumors are rare, CS must be considered when presented with a solid subglottic or neck mass.

Chondrosarcoma of the larynx

A case of a low grade chondrosarcoma of the cricoid cartilage which had been diagnosed initially as a chondroma is presented. The tumour recurred twice after limited surgical resections. Total laryngectomy was inevitable due to near total involvement of the cricoid cartilage and subsequent histological examination revealed a low grade chondrosarcoma. We have discussed in brief, the diagnosis and treatment of chondrosarcomas of the larynx and support the view of conservative surgical management for low grade tumours as they are slow growing and metastases are infrequent. A total laryngectomy may be reserved for salvage or primarily when more than half of the cricoid cartilage needs to be resected. Histological grading reveals the biological behaviour of the tumour and CT scans help in planning the surgery. A regular follow-up is necessary for early detection of recurrences and metastases.

Laryngeal chondrosarcoma--an unusual presentation

Laryngeal chondrosarcoma is an uncommon tumour, approximately 200 cases having been reported in the world literature. We report a case which was noted by chance in a patient undergoing general anaesthesia for an unrelated procedure.

Chondrosarcoma of the larynx after radiation treatment for vocal cord cancer

The case of a 57-year-old man with chondrosarcoma of the laryngeal cartilage is presented, occurring 16 years after radiation treatment for squamous cell carcinoma of the right true vocal cord. Chondrosarcoma of the larynx is an uncommon tumor. The location, grade, and time elapsed from initial treatment make it probably that this patient's chondrosarcoma is associated with his prior radiation treatment. However, it is a rare occurrence, this being the second case reported in the literature.

Laryngeal chondrosarcoma: incidence, pathology, biological behavior, and treatment

Chondrosarcoma is the most common mesenchymal tumor of the larynx and approximately 200 cases have been collected in the world medical literature. It is less aggressive in the larynx than elsewhere: cervical or distant metastases are rare (8.5%), and although local recurrences are not uncommon, they are not catastrophic. A retrospective study was made on eight cases of laryngeal chondrosarcoma. Three cases had originally been diagnosed as idiopathic vocal cord paralysis, possibly because of early involvement of the cricoarytenoid joint or the distal portion of the recurrent nerve. This fact emphasizes the need for accurate laryngeal computed tomography in cases of vocal cord paralysis of unknown origin. Surgical excision is the treatment of choice for laryngeal chondrosarcoma, and conservative techniques may sometimes be appropriate. Supraglottic laryngectomy may be the technique of choice in the rare cases of epiglottic involvement.