Laryngeal chondrosarcoma.

Chondrosarcoma of the larynx is a tumor of cartilaginous origin--usually a low-grade malignancy--that accounts for approximately 0.5% of all primary laryngeal tumors. (1) The male-to-female ratio is approximately 4:1, and the mean age of patients is 64.4 years. (1,2)

Computed tomography (CT) is highly sensitive for demonstrating chondroid tumors (figure 1). Coarse or stippled calcifications within the tumor mass can be seen on both plain films and CT in nearly all cases. Calcification is probably the most helpful imaging feature for identifying a neoplasm of the laryngeal cartilage, although this finding does not necessarily distinguish a chondroma from a chondrosarcoma. Less common CT findings are (1) a noncalcified mass that is isodense to muscle and cartilage, (2) bone destruction, and (3) local invasion of the adjacent structures, which is seen with more aggressive tumors and which can compromise the airway. (3) Although magnetic resonance imaging is highly sensitive for detecting soft tissue extension of tumors, it does not identify the calcified matrix present in these tumors.

[FIGURE 1 OMITTED]

Laryngeal chondrosarcoma affects the cricoid cartilage (72% of cases) more than other laryngeal cartilages and more than thyroid and arytenoid cartilages. (1,2) The most common symptoms are hoarseness, dyspnea, and dysphagia, in that order. Laryngeal chondrosarcomas tend to grow slowly, and patients may experience symptoms for several years before diagnosis. (4) On endoscopic examination, these tumors can appear as subglottic masses with intact overlying mucosa; ulceration is rare. Findings on histologic examination following biopsy vary; findings can range from a well-differentiated chondroma or low-grade chondrosarcoma to the anaplastic features of a high-grade chondrosarcoma (figure 2). (1,2) However, differentiation can be difficult. For the most part, a laryngeal chondrosarcoma can be considered a low-grade neoplasm, both histologically and clinically.

[FIGURE 2 OMITTED]

Conservative surgery is the treatment of choice for laryngeal chondrosarcomas, and the specific modalities and techniques have been the subject of discussion in the literature. Overall, the literature supports a surgical approach in which laryngeal function is preserved. (1)

References

(1.) Thompson LD, Gannon FH. Chondrosarcoma of the larynx: A clinicopathologic study of 111 cases with a review of the literature. Am J Surg Pathol 2002:26:836-51.

(2.) Rinaldo A, Howard DJ, Perlito A. Laryngeal chondrosarcoma: A 24-year experience at the Royal National Throat, Nose and Ear Hospital. Acta Otolaryngol 2000; 120:680-8.

(3.) Cure J. Neoplasm, malignant tumors: Chondrosarcoma, larynx. In: Harnsberger HR, Hudgins PA, Wiggins RH Ilk eds. Diagnostic Imaging: Head and Neck, Section III. Salt Lake City: Amirsys, 2004:28ff.

(4.) Wang SJ, Borges A, Lufkin RB, et al. Chondroid tumors of the larynx: Computed tomography findings. Am J Otolaryngol 1999:20:379-82.

From the Department of Radiology (Dr. Eraso and Dr. Palacios) and the Department of Pathology (Dr. Lorusso), Louisiana State University Health Sciences Center, New Orleans.