Cartilaginous tumors of the larynx. Chondrosarcoma of the larynx.
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CHONDROSARCOMA of the larynx is a rare lesion. Havens and Parkhill1reviewed 1,100 cases of malignant tumor of the larynx observed at the Mayo Clinic from 1910 to 1940. They found only 11 cases of sarcoma, of which two were chondrosarcomas. In that series carcinoma occurred 100 times as frequently as sarcoma. Clerf2reported that 740 cases of carcinoma of the larynx were encountered from 1930 to 1946 at the Jefferson Hospital. During this time only eight sarcomas, of which one was classified as chondrosarcoma, were observed. Jackson and Coates3found no instances of sarcoma in a series of 643 cases of malignant tumor of the larynx observed up to 1929. Thomson and Colledge4observed only one case of sarcoma in their experience. Eighty-nine cases of chondroma of the larynx have been reported in the literature. Moore5found 53 cases recorded before 1925. McCall6
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Cartilaginous tumors of the larynx, while rare, will on occasion be encountered by the otolaryngologist in routine daily practice. True laryngeal chondromas are exceedingly rare, and as a consequence, a putative diagnosis of chondroma should be viewed with suspicion. On pathologic examination, laryngeal chondromas usually prove to be small lesions (less than 2 cm in maximum dimension) and may arise in children or adults. Laryngeal chondrosarcomas, by contrast, usually prove to be larger lesions (exceeding 3 cm in greatest dimension) and are typically found in adults. While high-grade chondrosarcomas are readily identifiable on light microscopic study, the distinction between a chondroma and a low-grade chondrosarcoma is often not so clear-cut. Some low-grade chondrosarcomas may show a slight increase in both cellularity and cytologic atypia when compared with chondromas, but the two patterns often overlap. When faced with a limited biopsy specimen of a laryngeal cartilaginous lesion in which neither increased cellularity nor recognizable cytologic atypia is found, a diagnosis of “cartilaginous tumor without obvious evidence of malignancy — further classification dependent on examination of the lesion in its entirety,” or words to this effect, is recommended.
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Computerized tomography is the imaging method of choice for evaluation of neoplastic involvement of the larynx. There are unusual primary neoplasms of the larynx which include chondroma and chondrosarcoma. These lesions may cause vocal cord paralysis and respiratory symptoms secondary to compression of the recurrent laryngeal nerve. We present a single patient with computerized tomographic imaging of laryngeal chondrosarcoma resulting in unilateral vocal cord paralysis and hoarseness.
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Chondrosarcoma of the larynx is a rare neoplasm. The characteristic features of this tumor are described, and a case in a 69-year-old woman is reported. This case demonstrates the difficulties of histological classification. On the first biopsy specimen a benign chondroma was diagnosed. However, the microscopical features of the excised tumor were those of a chondrosarcoma. It is generally accepted that radiotherapy is of no value; surgical treatment by laryngectomy is advised. Some authors recommend a conservative attitude towards these tumors, which are of low malignancy, the growth slow and the risk of local or distant metastases slight.
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Chondroma and laryngeal chondrosarcomas, tumours of variable malignancy, are rare but a source of concern given their location and the surgery involved. Their anatomical limits and classification are still difficult, to the extent that the diagnosis of chondroma is often questioned. Of the four cases reported, two presented a high degree of malignancy, including one with metastasis. Two required a total laryngectomy, and two a partial laryngectomy with a costal cartilage graft in one case.
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The characteristic features of chondroma and chondrosarcoma of the larynx (less than 1% of laryngeal tumors) are discussed in a case report. Laryngoscopy (rounded, smooth tumor, covered by normal mucous membrane) and HR-CT of the larynx (swelling of the cartilages, calcifications in 80% of cases) give a characteristic view of the tumor, so that, by synopsis of both, a definite diagnostic statement concerning the kind of tumor is possible. However, carcinoma of the larynx with invasion of the cartilage, laryngeal manifestation of multiple chondromatosis and calcification after severe trauma have to be differentiated from cartilaginous tumors of the larynx. The adequate therapy of chondroma and low-grade chondrosarcoma consists of partial laryngectomy and reconstruction of the air passages. High-grade chondrosarcoma should be treated with radical laryngectomy.
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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. We reviewed the salient histological features of cartilaginous laryngeal lesions to provide differential diagnostics and guidelines for distinguishing the benign from the malignant ones. 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. 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.
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