Adult Laryngeal Ossified Hemangioma: Difficulties in Differential Diagnosis
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Abstract Adult laryngeal hemangiomas are uncommon and often poorly symptomatic. The authors describe a laryngeal hemangioma with acute airway obstruction and radiologic findings suggesting a chondrosarcoma-like neoplasm, while pathologic features were consistent with an ossified hemangioma. The presence of fields of bone metaplasia into a classical cavernous hemangioma is an unusual phenomenon which, to our knowledge, was never previously described in the larynx. Difficulties concerning the differential diagnosis and modality of treatment are also discussed.Keywords:
Airway obstruction
Chondrosarcoma of the larynx is a rare malignant tumor sometimes encountered by otolaryngologists. Since they are usually of low grade malignancy, total laryngectomy is indicated only in cases of high grade malignancy or where total excision by conservative (partial) laryngectomy is not feasible. This paper reviews chondrosarcoma of the larynx, discusses a patient who developed this tumor, and describes a method of conservative surgical excision and laryngotracheal reconstruction when the tumor involves the cricoid, the most common site of occurrence in the larynx.
Cricoid cartilage
Conservative Management
Conservative Treatment
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Chondrosarcoma of the larynx is an uncommon, slow-growing malignant tumor of the larynx which tends to metastasize late. This paper adds to the literature a case which was followed for 18 years. During the first three years is was thought to be a benign chondroma. Conservative management by limiting surgical resection, at the patient's direction, allowed observation of the disease for this unusual length of time. Massive enlargement finally necessitated laryngectomy. The lesion, though unquestionably malignant, had not infiltrated adjacent neck structures and appears to have been totally excised, with the patient now being free of disease six months after surgery. This supports the view of conservative surgical management.
Chondroma
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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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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 probable 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.
Thyroid cartilage
Cricoid cartilage
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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.
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Hemangioma of the larynx is an uncommon condition. Irwin Moore1in 1923 was able to find only 76 cases in the literature; these included his own reported at that time. Hückel2in 1928, in a study of the records of a series of 26,999 patients admitted to the Göttinger Institute, reported the occurrence of 123 benign tumors of the larynx; of these only 4 were hemangiomas. New and Erich,3in reviewing the cases observed at the Mayo Clinic during the last thirty years, found 722 benign tumors of the larynx; 26 of these growths were hemangiomas. Laryngeal hemangiomas were first classified by Sweetser4in 1921, into the adult and the infantile type. The former type occurs usually on or above the vocal cords, and the latter, subglottically. The hemangioma in the case we are about to report falls into the infantile group. We have been able to find only 5
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Chondrosarcoma of the larynx is extremely rare in young people. Total laryngectomy to treat this tumor in young patients would have a markedly deleterious effect on the long-term quality of life of the patients. Therefore, it would be worthwhile attempting larynx-preserving surgery in such patients. Herein, we report a case of chondrosarcoma arising from the cricoid cartilage in a young patient.
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Thyroid cartilage
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Two cases of laryngeal chondrosarcoma are described. The first exhibited a fibrosarcomatous differentiation, which is a rare finding in chondrosarcoma and usually indicates poor prognosis. The second was found in a larynx six years after Teflon injections for the treatment of vocal cord paralysis. The possibility of Teflon as a tumorigenic factor in this case is raised.
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Vocal Cord Paralysis
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