Laryngeal chondrosarcoma: a 24-year experience at the Royal National Throat, Nose and Ear Hospital

Treatment strategy in laryngeal chondrosarcoma: a multicenter study of 43 cases

PURPOSE

Laryngeal chondrosarcoma is a rare tumor that mostly affects the cricoid cartilage. The aim of this study was to compare outcomes between the various treatments of this pathology as there are no official guidelines for this pathology.

METHODS

A retrospective analysis of the pathology database of nine French tertiary care centers was conducted. Outcomes of patients treated by total laryngectomy were compared with those treated by more conservative approaches (endoscopic debulking, median thyrotomy, partial laryngectomy). Two Kaplan-Meier survival analyses were performed: one to assess the overall survival rate and the other to assess laryngeal preservation over time.

RESULTS

A total of 43 patients were enrolled: 12 with total laryngectomy as the initial treatment, and 31 who initially underwent laryngeal-preserving treatment. With conservative treatment, laryngeal function was preserved in 96% and 75% of patients at 1 and 5 years, respectively. Conservative treatment did not reduce the overall survival rate.

CONCLUSION

These results suggest that laryngeal preservation should be considered as the initial treatment in cases of laryngeal chondrosarcoma.

Hemicricoidectomy with modified rotational thyro-crico-tracheal anastomosis: a newborn in the family of crico-tracheal resection and anastomosis techniques

Objective

The aim of the present study is to describe our novel surgical technique of hemicricoidectomy and reconstruction with modified rotational thyro-crico-tracheal anastomosis for the treatment of non-squamous cell subglottic tumours. The procedure has been defined as Type E crico-tracheal resection and anastomosis (CTRA) following the University of Brescia (C)TRA classification introduced elsewhere.

Methods

A detailed anatomical step-by-step dissection was reproduced and illustrated on a cadaveric laryngo-tracheal specimen. Moreover, oncological and functional outcomes of the first 5 patients who underwent Type E CTRA at our Institution between October 2016 and September 2022 are described.

Results

Three patients underwent Type E CTRA for cricoid chondrosarcoma (CS) and 2 patients for subglottic adenoid cystic carcinoma (ACC). No post-operative complication was reported. All patients maintained intact oral intake and an intelligible voice at discharge. All but one patient with obstructive sleep apnoea hypopnea syndrome and lung comorbidity were successfully decannulated before discharge. At the last follow-up (April 2023), one patient experienced local recurrence of CS that was still amenable to conservative treatment by transoral debulking, while the remaining patients were free of disease.

Conclusions

With the proper indications, Type E CTRA is a feasible and effective conservative surgical technique for selected non-squamous cell subglottic tumours.

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.

Survival outcomes in laryngeal chondrosarcoma: a systematic review

Laryngeal chondrosarcomas (LCS) are rare lesions that behave as locally aggressive tumours, producing symptoms such as dysphonia, dyspnoea, dysphagia and hoarseness. Different approaches for the treatment of LCS have been described in the literature. The main purpose of this investigation was to find all cases of LCS published to date and analyse management data and survival outcomes. In December 2020, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Provider Enrollment, Chain, and Ownership System (PECOS) method including articles published up to this date on different aspects of LCS. The search included the terms larynx, laryngeal, chondrosarcoma. A total of 148 articles were included in this systematic review describing 381 cases of LCS. Dyspnoea was the most reported symptom followed by hoarseness and neck mass sensation. Cricoid cartilage was the most usual location. Survival rate was influenced by both surgical technique (log-rank = 11.7; p = 0.008) and the degree of tumour histologic differentiation (log-rank = 18.3; p = 0.003).

Organ Preservation Strategies in Laryngeal Chondrosarcoma

OBJECTIVES/HYPOTHESIS

Laryngeal chondrosarcoma (LC) is a rare, slowly growing malignancy. The preferred treatment is laryngeal preservation surgery (LPS). Some patients may require multiple interventions or total laryngectomy (TL). We investigated risk factors for retreatment and TL, and assessed the impact of LPS on oncological and functional outcomes.

STUDY DESIGN

Case series METHODS: We searched our institution database for LC. Tumor grading, localization, and margin status were tested as predictors of recurrence and organ preservation.

RESULTS

We included 21 patients (seven females, mean age 58 ± 12 years). LPS was applied in 20 (95.2%) of them as a primary procedure. Six patients were treated by transoral approach and 14 received "open-neck" LPS. Fifteen (71.4%) were operated only once, while six patients underwent a total of 15 adjunctive procedures. Additional operations were always performed for recurrence of tumors localized within the cricoid plate. The histological grading was G1 in 81% and G2 in 19%. However, two patients with a primary G1 LC showed a G2 recurrence. Reoperations for recurrence were more frequent among patients with G2 in respect to G1 histology (83% vs. 7%, P < .001). Fifty percent of G2 LC and 8% of G1 underwent TL (P < .05). Margin status had no influence on recurrence rate.

CONCLUSIONS

Patients with G2 LC have more recurrences requiring surgery and a higher incidence of TL. Cricoid plate localization is relevant for organ preservation. Margin status signals possible disease persistence, without influencing the need for future surgeries. Need for reoperation entails a risk of not being able to maintain organ functionality.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Nonepithelial Tumors of the Larynx: Single-Institution 13-Year Review with Radiologic-Pathologic Correlation

Nonepithelial tumors of the larynx are rare and represent a minority of all laryngeal neoplasms. Imaging has an important role in the diagnosis, treatment planning, and surveillance of these entities. However, unfamiliarity with these neoplasms can cause diagnostic difficulties for radiologists, especially because many of the imaging findings are nonspecific. By using a systematic approach based on clinical history, patient age and gender, lesion location, endoscopic results, and specific imaging findings, the differential diagnosis can often be narrowed. These tumors typically affect the submucosal layer, so if a tumor has an intact mucosa at endoscopy, a nonepithelial neoplasm is the most likely diagnosis. Nonepithelial tumors of the larynx can arise from the laryngeal cartilage or muscle or from the surrounding lymphoid tissue or blood vessels. Consequently, imaging findings typically correspond to the specific cell type from which it originated. Recognizing specific features (eg, metaplastic bone formation, macroscopic fat, or enhancement pattern) can often help narrow the differential diagnosis. In addition, identification of noncircumscribed borders of the lesion and invasion of the adjacent structures is key to diagnosis of a malignant process rather than a benign neoplasm. Understanding the pathologic correlation is fundamental to understanding the radiologic manifestations and is ultimately crucial for differentiation of nonepithelial laryngeal neoplasms. Online supplemental material is available for this article. ^©RSNA, 2020.

Chondrosarcoma of Nasal Cavity: a Rare Entity

Chondrosarcoma of nasal cavity is a rare entity, and only few case reports exist. Diagnosis is made on histopathological analysis. Differentiating chondrosarcoma from chondromas can be challenging. Surgical excision remains the treatment of choice. We report a case of a 73-year-old male who presented to us with complaints of bilateral nasal obstruction. Histopathology reported as moderately differentiating chondrosarcoma. Patient subsequently underwent excision of tumor by craniofacial resection with adjuvant radiotherapy. Patient is on regular follow-up and has shown no evidence of recurrence.

Differing characteristics of cartilaginous lesions of the larynx

Introduction

The tissues of the laryngeal region only rarely harbor primary cartilaginous lesions, and squamous cell carcinoma remains the most frequently encountered malignant tumor in this area.

Materials and Methods

We reviewed the salient histological features of cartilaginous laryngeal lesions to provide differential diagnostics and guidelines for distinguishing the benign from the malignant ones.

Results

Cartilaginous neoplasms of the larynx include chondroma and chondrosarcoma. Among the overarching group of all forms of laryngeal sarcoma, chondrosarcoma forms the most common entity in the larynx, followed by rhabdomyosarcoma. Cartilaginous tumors comprise about 0.1%–1% of all laryngeal neoplasms with chondrosarcomas being more frequently encountered than chondromas. Several neoplasms earlier reported as giant-cell tumors of the larynx would most likely, using current terminology, be classified as cases of undifferentiated pleomorphic sarcoma (previously known as malignant fibrous histiocytoma, giant-cell variant) or aneurysmal bone cyst.

Conclusion

When true laryngeal sarcomas do exist, they may prove to be challenging lesions both for the pathologist and the treating clinician. The diagnostic problems are mainly a result of the infrequent exposure of clinicians and diagnosticians to these lesions.

A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma

Laryngeal chondrosarcoma is a rare laryngeal tumor that most frequently originates from the cricoid cartilage. The majority of lesions are low grade and the distinction from benign chondromas must be made. We present a case of a laryngeal chondrosarcoma arising from the cricoid cartilage in a 75-year-old Arab man who presented with hoarseness, dysphonia, and dyspnea. Endoscopic and radiological examinations showed a mass of the wall of his larynx with displaced structures, airway obstruction, and destruction of the cartilage. The patient underwent total laryngectomy. Histological examination supported the diagnosis of low-grade chondrosarcoma. Five months later, the radiological and clinical findings showed no evidence of recurrence or metastases. Laryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, given the importance of preserving the larynx to patients' quality of life. The prognosis is favorable and metastases rarely occur.

Laryngeal sarcomas: A case series of 5 cases

Primary sarcomas of the larynx are rare and miscellaneous. The most common is chondrosarcoma. Other sarcomas are very rare. Sarcomas can have heterogeneous morphologic features of spindle, small round, epithelioid, pleomorphic and giant cells. Laryngeal sarcomas may mimic carcinomas, lymphomas, small cell carcinoma, mesothelioma and melanoma. This imposes diagnostic challenges for unfamiliar pathologists particularly in small laryngeal biopsies. Our aim was to study the different types of sarcomas that can involve the larynx in our institution, to investigate their diagnostic challenges and potential pitfalls and to find helpful histologic clues to avoid misinterpretation and missed diagnosis. We performed a retrospective review study over 13 years. We retrieved 5 cases of laryngeal sarcomas. They included Kaposi sarcoma, low-grade chondrosarcoma, epithelioid angiosarcoma, polypoid leiomyosarcoma and small cell osteosarcoma. The age range was between 32 and 74 years with an average age of 52 years. The male to female ratio was 3:2. The Kaposi sarcoma and chondrosarcoma were correctly diagnosed. The angiosarcoma was initially missed as recurrent carcinoma. The leiomyosarcoma was initially inferred as polypoid sarcomatoid squamous cell carcinoma. The small cell osteosarcoma initiated the differential diagnosis of high-grade lymphoma, small cell carcinoma, undifferentiated carcinoma, Ewing sarcoma and rhabdomyosarcoma. An implementation of a panel of immunohistochemical markers guided by certain histomorphologic clues was helpful to make the correct diagnosis. Pathologists should be aware of the morphologic spectrum and different growth patterns of laryngeal sarcomas. Immunohistochemistry studies are essential. Correct diagnosis, classification and grading of laryngeal sarcomas are clinically important for the prognosis and appropriate management of patients.

Clear cell chondrosarcoma of the larynx

Chondrosarcomas represent a group of malignant tumours composed of cells producing cartilage, and clear cell chondrosarcomas (CCC) represent a variant of these. A rare case of a laryngeal CCC is presented. The patient was a 70-year-old man who presented with a 6-week history of throat pain, worsening dysphonia and a lump in the neck. Examination revealed a level 3 neck mass and positron emission tomography imaging revealed a metabolically active right laryngeal mass. Biopsies revealed a cartilaginous neoplasm. The patient underwent total laryngectomy, and the pathology confirmed CCC of the larynx. Chondrosarcomas are the most common type of sarcoma in the larynx but the CCC variant is rare. CCC are usually low-grade tumours affecting long bones, with a male predominance. Less than six cases have been described in the literature affecting the larynx. Management of these malignancies is complete surgical excision given the high risk of local recurrence.

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.

Conservative surgery for laryngeal chondrosarcoma: a review of the most recently proposed approaches

PURPOSE OF REVIEW

The aim of this study was to describe the most recent technical nuances for resection and reconstruction of Grade 1 and 2 laryngeal chondrosarcomas, with a special emphasis on those located at the level of the cricoid plate, which is the site of origin of the vast majority of these rare tumours.

RECENT FINDINGS

Even though inherently based on retrospective small clinical series or anecdotal case reports, a number of studies have been recently published focusing on conservative transoral and open-neck surgical procedures aimed at an oncologically sound removal of the tumour together with organ and function preservation. The open-neck conservative approaches herein reported can be roughly distinguished in those achieving a primary airway reconstruction by a tracheo-hyoido-epiglottopexy or an end-to-end crico-tracheal, thyro-crico-tracheal or thyro-tracheal anastomosis, and those requiring a single or double-staged transposition of different microvascular flaps, with or without cartilaginous graft insertion, to reconstruct a subtotal/total cricoidectomy and obtain a rigid and stable subglottic airway.

SUMMARY

No meaningful comparison in terms of oncologic and functional outcomes is still possible among the currently available conservative surgical strategies, due to the rarity of laryngeal chondrosarcomas and the heterogeneity of treatments proposed in the literature. However, a reasonable algorithm to approach this difficult clinical entity according to its site of origin and extent of cricoid circumference involved is herein presented.

Dedifferentiated chondrosarcoma of the larynx: Radiological, gross, microscopic and clinical features

Laryngeal chondrosarcoma is an uncommon malignancy with a predilection for the cricoid cartilage of adult male patients. Although rare, identification of aggressive chondrosarcoma variants, such as dedifferentiated chondrosarcoma (DDCS) may influence preoperative patient counseling, definitive surgical management, potential implementation of post-operative adjuvant therapy and prognosis. Herein we describe clinical and imaging features of laryngeal DDCS, the unique perspective of fresh and formalin fixed macroscopic examination, a spectrum of histopathologic findings, and detail the full course of the patient's disease.

Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation

INTRODUCTION

Laryngeal cartilaginous framework tumors are very rare. Chondroma and chondrosarcoma are the most common types of these tumors.

PATIENT PRESENTATION

A 27-year-old man with a history of intubation presented with exercise-induced dyspnea. A computed tomography scan of larynx showed a rounded and circumscribed mass without infiltration of the adjacent structures which obstructs 75% of airway. Histopathological investigation of the mass revealed the chondroma of the larynx. The patients' history of intubation trauma with the subsequent progressive onset of clinical symptoms demonstrates the relationship between these 2 entities.

CONCLUSION

Clinicians should consider laryngeal chondroma in the differential diagnosis of dyspnea after endotracheal intubation.

Primary chondrosarcoma of the thyroid cartilage: Surgery-based management of a rare case

In this study, we present a case of a 52-year-old male with a chondrosarcoma of the left lamina of the thyroid cartilage. Pre-operative evaluations detected typical calcifications and delineated the extent of the tumor. The patient underwent a total laryngectomy to ensure the complete resection of the tumor. The tumor was histopathologically found to consist of chondrocytes in a hyaline cartilage matrix. The patient's post-operative course has been successful apart from the permanent tracheostomy. Herien, we discuss the methods and rationales for the diagnosis and management of and recovery from this rare tumor, and also provide a review of the literature.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes

BACKGROUND

Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.

OBJECTIVES

This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.

METHODS

Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.

RESULTS

The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.

CONCLUSION

Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

Rotational thyrotracheopexy after cricoidectomy for low-grade laryngeal chrondrosarcoma

OBJECTIVES

The complex laryngeal functions are fundamentally defined by the cricoid cartilage. Thus, lesions requiring subtotal or total resection of the cricoid cartilage commonly warrant total laryngectomy. However, from an oncological perspective, the resection of the cricoid cartilage would be an optimal solution in these cases. The poor functional results of the few reported cases of total and subtotal cricoidectomy with different reconstruction techniques confirm the need for new approaches to reconstruct the infrastructure of the larynx post cricoidectomy.

STUDY DESIGN

Retrospective case series review.

METHODS

Four consecutive patients with low-grade chondrosarcoma were treated by cricoidectomy with rotational thyrotracheopexy reconstruction to enable the functional creation of a complete cartilaginous ring that can substitute the functions of the cricoid cartilage. The glottic structures were stabilized with endoscopic arytenoid abduction lateropexy. Patients were evaluated with objective and subjective function tests.

RESULTS

Tumor-free margins were proven; patients were successfully decannulated within 3 weeks. Voice outcomes were adequate for social conversation in all cases. Oral feeding was possible in three patients.

CONCLUSION

Total and subtotal cricoidectomy can be a surgical option to avoid total laryngectomy in cases of large chondrosarcomas destroying the cricoid cartilage. The thyrotracheopexy rotational advancement technique enables the effective reconstruction of the structural deficit of the resected cricoid cartilage in cases of total and subtotal cricoidectomy. An adequate airway for breathing, swallowing, and voice production can be reconstructed with good oncological control. In cases where the pharynx is not involved, good swallowing function can also be achieved.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1109-1115, 2017.

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.

Primary laryngeal clear cell chondrosarcoma: report of a case and literature review

We present an example of clear cell chondrosarcoma (CCC) arising in the thyroid cartilage, and review the literature regarding this neoplasm in the larynx. This patient has no evidence of disease 3 years post hemilaryngectomy. Although rare and morphologically distinct, CCC follows the same benign clinical course as conventional laryngeal chondrosarcoma.

Laryngeal chondrosarcoma: a population-based analysis

OBJECTIVES/HYPOTHESIS

Laryngeal chondrosarcoma (LC) is a rare entity, reportedly comprising less than 1% of all laryngeal tumors. Consequently, the incidence and survival of patients with this slow-growing tumor has been difficult to study. Our objective was to evaluate incidence, organized by patient demographics, as well as long-term survival trends of this malignancy using a population-based database.

STUDY DESIGN

Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry.

METHODS

The SEER database was searched for patients diagnosed with LC between 1973 and 2010. Data analyzed included patient demographics, incidence, treatment modality, and survival.

RESULTS

One-hundred and forty-three cases were identified, representing 0.2% of all laryngeal tumors. Median age at diagnosis was 61.7 years. Men and women constituted 76.2% and 23.8% of patients, respectively. Tumors were locally invasive with 37.7% T4 disease and infrequent regional and distant metastases. The 1-year, 5-year, and 10-year disease-specific survival for LC was 96.5%, 88.6%, and 84.8%, respectively, compared to 88.3%, 68.2%, and 59.3%, respectively for patients with all other laryngeal tumors (P values < 0.01). Relative survival was 94.9% at 1 year, 88.5% at 5 years, and 88.4% at 10 years.

CONCLUSIONS

This analysis represents the largest LC study sample to date, allowing for evaluation of incidence and long-term survival. LC occurs infrequently, is locally invasive, but only rarely metastasizes. Prognosis for LC is significantly better than for other laryngeal malignancies.

Chondrosarcomas of the head and neck

Chondrosarcoma represents approximately 11% of all primary malignant bone tumors. It is the second most common sarcoma arising in bone after osteosarcoma. Chondrosarcomas of the head and neck are rare and may involve the sinonasal tract, jaws, larynx or skull base. Depending on the anatomical location, the tumor can produce a variety of symptoms. Computed tomography and magnetic resonance imaging are the preferred imaging modalities. The histology of conventional chondrosarcoma is relatively straightforward; major challenges are the distinction between grade I chondrosarcomas and chondromas, and the differential diagnosis with chondroblastic osteosarcoma and chondroid chordoma. Surgery alone or followed by adjuvant radiotherapy is the treatment of choice. Radiotherapy alone has also been reported to be effective and can be considered if mutilating radical surgery is the only curative alternative. The 5-year survival for chondrosarcoma reaches 80%; distant metastases and/or local recurrences significantly worsen prognosis. The present review aims to summarize the current state of information about the biology, diagnosis and management of these rare tumors.

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.

[Chondrosarcoma of the larynx. Experience gained in Freiburg since 1999]

BACKGROUND

Chondrosarcomas are rare tumors of the head and neck. Nevertheless, they display the most common non-epithelial malignancy of the larynx.

MATERIALS AND METHODS

Between 1999 and February 2010 we treated six patients with laryngeal chondrosarcoma. The group included two female and four male patients ranging in age from 54 to 82 years.

RESULTS

An 82-year-old female patient died 3 months after diagnosis and tracheostomy due to other underlying diseases. An 82-year-old male patient underwent primary radiation therapy. In the other patients, we performed a modified hemilaryngektomy in three cases and a laryngectomy in one. In those four cases, there were no signs of recurrent disease 50, 85, 87 and 95 months after surgery, respectively. There were no local or distant metastases.

CONCLUSIONS

Chondrosarcomas of the larynx are slow growing neoplasms. Metastases occur in less than 3% of cases. Complete resection is the therapy of choice. Function-preserving surgical approaches should be favoured.

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.

[Surgical treatment of head and neck chondrosarcomas]

INTRODUCTION

Head and neck chondrosarcomas may adopt different locations and biological behaviour.

MATERIAL AND METHOD

We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006.

RESULTS

Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach.

CONCLUSION

Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment.

Laryngeal Chondrosarcoma: an Exceptional Localisation of a not Unfrequent Bone Tumor

After osteosarcoma, chondrosarcoma is the second most common primary bone tumor accounting for 26% of all malignancies. In the laryngeal region however, chondrosarcomas are rather rare. Only 300 cases are reported in literature. Considering laryngeal chondrosarcoma, about 75% occur in the cricoid cartilage, whereas 20% occur in the thyroid cartilage. In this paper we report a case of thyroidal chondrosarcoma, and based on a thorough literature search we suggest some practical guidelines concerning diagnosis and therapy.

[Chondrosarcomas of the larynx and sinus maxillaris--review of literature and report of three cases]

Chondrosarcoma is a very rare neoplasm in the head and neck region. This region is associated with favourable prognosis. Only 340 cases of chondrosarcoma of the larynx and nearly 300 of sinus maxillaris have been reported in this localization. The most reasonable treatment is radical surgery. Radiotherapy and chemotherapy are of little value. Without metastasis the long term prognosis is excellent. Clinical, pathologic and radiologic characterities of these tumors are described and review of the literature is presented. The authors present two cases chondrosarcoma of the larynx and one case chondrosarcoma of sinus maxillaries.

Endoscopic resection of low grade, subglottic chondrosarcoma

Introduction:

This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.

Method:

Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.

Results:

Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.

Summary:

Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

Chondrosarcoma of the Arytenoid Cartilage: A Case Report and Review of the Literature

We report the case of a 56-year-old black woman with a locally aggressive chondrosarcoma at an unusual tumor site: the right arytenoid cartilage. The tumor extended from the superior pole of the right arytenoid cartilage to the soft-tissue areas of the right aiyepiglottic fold, piriform sinus, and interarytenoid area. We undertook a conservative surgical approach by performing an endoscopic transoral CO2 laser resection, a right arytenoidectomy with wide soft-tissue margins, and a tracheotomy in anticipation of postoperative edema. Surgical exploration revealed that the tumor extended into the cricoid cartilage. Histopathology demonstrated a low-grade chondrosarcoma of the conventional variant. Clear margins were obtained by staged procedures. Chondrosarcomas of the larynx typically exhibit low-grade histopathology, and affected patients have a low incidence of metastasis and a good prognosis. Even so, these tumors can present diagnostic and therapeutic challenges. Surgical resection provides adequate airway protection and sound oncologic safety while preserving speech and swallowing, and these should be the surgeon's goals in this setting. Options include open laryngofissure, thyrotomy, organ preservation with partial laryngectomy, and endoscopic laser resection.

Chondrosarcoma of larynx: review of literature and clinical experience

Laryngeal chondrosarcomas are rare, cartilaginous tumours, and around 300 cases have been reported in the literature. They are slow-growing tumours which present difficulties both in diagnosis and treatment. Most patients eventually require radical surgery. However, over the last 10 years, we have diagnosed two cases of laryngeal chondrosarcoma and managed them conservatively by endoscopic debulking and regular follow up. The objective of this article is to highlight the conservative approach in managing these patients, particularly in the presence of co-morbid conditions.

[Chondrosarcoma of the cricoid]

OBJECTIVE

Chondrosarcoma of the larynx is a rare neoplasm generally observed on the cricoid. The purpose of this study was to define the most appropriate surgical management depending on tumor extension and histological grade.

PATIENTS AND METHODS

Three males and one female were treated for chondrosarcoma of the cricoid between 1990 and 2003 in the Ear, Nose and Throat department in Tours, France. There were three grade I tumors and one grade II tumor. Tumor resection by thyrotomy was performed in two patients, total laryngectomy in one and laser desobstruction in one.

RESULTS

The patient who underwent total laryngectomy remained in complete remission at five years. Among the two patients who had thyrotomy, one remained in remission at three years and the other experienced recurrence at four years and underwent a second operation. He died five years later due to another disease. Total follow-up was nine years. The patient treated by laser therapy achieved stabilization at twelve months.

CONCLUSION

Computed tomography and histological grading enable choosing the best surgical procedure. Partial laryngeal surgery is indicated for small or low-grade chondrosarcomas. For large or high-grade tumors, total laryngectomy must be performed. In the event of patient refusal, laser desobstruction can provide clinical stabilization.

Chondrosarcoma of the parapharyngeal space

Chondrosarcomas are the malignant cartilagenous tumors and they are seen rarely in the head and neck area. They are usually slow growing lesions. The head and neck chondrosarcomas may show an aggressive course and the occurrence of this malignant cartilagenous tumor in the parapharyngeal space is only a few. They are mostly located in relation with jaw bones and base of the skull. Chondrosarcomas of the parapharyngeal space are limited in number and among them there is no low-grade one. In this case report, a case of low-grade chondrosarcoma which was treated with a simple excision without neck dissection was reported.

Chondrosarcome laryngé

Chondrosarcoma is a malignant tumor relatively rare on the larynx, and raises diagnostic and therapeutic difficulties. Its diagnosis often requires the recourse to a radiological, endoscopic and anatomopathologic confrontation. Its treatment is exclusively surgical. It is based on broad excision sometimes mutilating and requires in this kind of localization a multidisciplinary collaboration between ORL, vascular surgeon and radiotherapy. In the light of a new very conclusive observation and data of the literature, we wanted to give a progress report on the clinical and therapeutic positions of the various authors.

Cricoid Chondrosarcoma Presenting as Arytenoid Hypertelorism

BACKGROUND

Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for Voice Disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open. In fact, patients with arytenoid hypertelorism caused by cricoid chondrosarcoma may be aphonic even though the anterior membranous vocal folds make contact during attempted phonation.

METHODS

Between 1991 and 2002, nine patients were diagnosed with cricoid chondrosarcoma. Patients' charts and video examinations were retrospectively evaluated for symptoms and the presence of arytenoid hypertelorism on endoscopic evaluation. Two were women, and seven were men, with a mean age of 70 (range 53-72) years at diagnosis.

RESULTS

Eight (88%) patients had aphonia or dysphonia caused by arytenoid hypertelorism as their presenting symptom. Six were diagnosed after failed medialization laryngoplasty or other laryngeal rehabilitation surgery. All nine patients had a low-grade tumor. The initial treatment in eight patients was hemicricoidectomy, and one patient had a total laryngectomy. In four cases, a second procedure was needed 1 to 6 years later because of recurrence. Seven patients are alive without clinically significant disease; one is alive with moderate disease, and one has died from an unrelated cause.

CONCLUSIONS

Severely dysphonic, elderly patients presenting with arytenoid hypertelorism of unknown cause should be evaluated by fiberoptic laryngoscopy and by computed tomography scan to rule out cricoid chondrosarcoma. Because these tumors behave so benignly, the authors recommend conservative surgery (unilateral hemicricoidectomy) as the diagnostic/treatment modality of choice.

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 Involvement of Rhabdomyosarcoma in an Adult

Background

Although initial presentation of sarcomas in the head and neck region is relatively common, involvements of the larynx by rhabdomyosarcoma either primary or metastatic have been reported rarely.

Case report

A case of rhabdomyosarcoma in the right thigh, which involved laryngeal structures three years after the diagnosis, is presented.

Conclusions

The laryngeal involvement by primary and metastatic rhabdosarcomas is very rare, however when it occurs it can result in life treating upper airway obstruction. After emergency intervention, radiotherapy and / or chemotherapy must be undertaken for long-term benefit and surgery may be helpful only in selected cases.

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.