Although the etiology of laryngeal chondrosarcoma is not
clearly understood, radiation exposure, teflon injection, and
disorganized ossification are important risk factors (1,8).
There are theories that ischemic changes in the chondroma
and chronic inflammation are also factors (9). It is thought
to be related to mechanical stress and smoking (5,9).
Although symptoms vary according to the localization of
the tumor, dyspnea and airway obstruction and a painless
mass may be observed in subglottic lesions (6).
It is difficult to estimate the true incidence of laryngeal
chondrosarcoma, as there have been cases of low-grade
chondrosarcoma diagnosed in the past as chondroma (9).
The average age at the time of diagnosis is 60-64 years and it
is more common in men (6,8). It is most commonly seen in
the posterior laminate of the cricoid and then in the thyroid
cartilage (9). Our case was an male patient who was older
than generally reported in the literature and the lesion was
located in the thyroid cartilage.
A 61-year-old patient reported by Moerman et al. had a lowgrade
chondrosarcoma located in the anterior part of the
thyroid cartilage (9). Sauter et al. reported chondrosarcoma
developing in two male patients, 93 and 66 years old (5).
Two cases reported by Wang et al. were located in the
cricoid and 2 cm in diameter, and consisted of low-grade
All of the 6 cases by Buda et al. consisted of male patients
(8). In addition to various surgical procedures, two
patients received radiotherapy and one patient received
One of two cases of Nao et al. was diagnosed with lowgrade
chondrosarcoma located in the thyroid cartilage (7).
Oliveira et al. presented 6 cases by reviewing the 10-year
larynx chondrosarcoma cases (3). Five of these cases were
located in the cricoid cartilage and only one was in the
thyroid cartilage (3). Five of the patients underwent total
laryngectomy (3). A 56-year-old woman with grade 2
tumor located in the thyroid cartilage underwent excision
of the left part of the thyroid cartilage (3) .
The diagnosis of low-grade chondrosarcoma can be delayed
as it is clinically a slow lesion (7).
On endoscopic examination, it can be observed as a
submucosal mass under smooth-looking mucosa, especially
in the posterior region, as well as with movement restriction
in the vocal cord (3).
Typical finding in CT is hypodense, well-cartied mass with
limited calcification (8). MRI is more useful in showing
paralaryngeal spread to the tissues (8).
Expansile lesions with popcorn-style calcifications on MRI
or CT are important in the diagnosis (5, 9, 10). The center
of the cartilage where the tumor is located has a hypodense
appearance (7). MRI examinations show hypointense
lesions on T1-weighted sections and hyperintense lesions
on T2-weighted sections (4, 7). Imaging methods may
not be made clear with the diagnosis of chondrosarcoma,
and 62% of chondrosarcoma cases may be associated with
Chondrosarcoma is macroscopically flat, in the form of
a lobular mass, and has a translucent appearance (8,10).
Tumor size is not related to prognosis, although it can be
between 1 and 10 cm in size (10). Deep endoscopic biopsy
and histopathological examination are required for a
definite diagnosis (4).
In the diagnosis of chondrosarcoma, histological criteria
such as cell and nucleus size irregularities, excessive
number of cells, hyperchromia, and chromatin aggregation
in single or multiple chondrocytes, which were defined by
Lichtenstein and Jaff in 1943, are used (5,9). Although the
criteria in larynx chondrosarcoma are not fully defined,
high cellularity, nuclear pleomorphism, and invasion
to neighboring structures are accepted as histological
diagnostic criteria. In particular, invasion into cartilage
tissue contributes to the diagnosis of chondrosarcoma
instead of chondroma. For this reason, it is advocated that
all material should be examined microscopically (9).
In the case reported by Ghatak et al., a 42-year-old male
patient was diagnosed with the biopsy of a 2 cm diameter
mass with an arytenoid location, and a low-grade
chondrosarcoma was diagnosed after the operation (2).
Laryngeal chondrosarcoma is graded histologically as grade
1, grade 2, and grade 3 (8). Most laryngeal chondrosarcoma
cases (80%) have a lower grade compared to other organ
Grade 1 chondrosarcomas are tumors with a good
prognosis, and the differential diagnosis with chondroma is
clinically, radiologically and pathologically difficult (7). In
cases of suspected malignancy, chondrosarcoma should be
considered in tumors over 2 cm (7).
In a review by Chin et al., 163 articles were reviewed among
articles published over 66 years (1). The average age of 513
patients was 62.5 years, and the male to female ratio was
3/1. The most common site was the cricoid cartilage (333 cases, 56.3%), and the second site was the thyroid cartilage
(68 cases, 11.5%) (1). Tumor sizes were an average of 3.7 cm
and the most common was histological grade 1 (289 cases,
Histologically, nuclear atypia, increased cellularity, and
invasion to neighboring structures are important in the
diagnosis (1). Excessive sampling is required to clearly
evaluate the separation of chondroma and chondrosarcoma
(1). Chondromas are tumors with a homogeneous lobular
growth pattern without hypocellular prominent atypia
(6). Chondromas are smaller than chondrosarcomas (3).
Chondromas consist of small mononuclear chondrocytes
with low cellularity. Hyperchromia, mitosis and necrosis are
not observed in the chondrocytes. Grade 1 chondrosarcomas
contain binuclear and multinuclear chondrocytes but do not
show mitosis. Grade 2 chondrosarcomas show increased
cellularity and rare mitosis. Grade 3 chondrosarcomas
are characterized by chondrocytes with a multinuclear
appearance with increased mitotic activity. The presence of
the myxoid matrix is also associated with more aggressive
behavior. The rate of metastasis increases with increasing
grade and is 10% in grade 2 chondrosarcoma (10). Our case
was grade 2 and no metastasis was observed.
Chondrosarcoma should be differentiated from laryngeal
nodular chondromalacia, fibrosarcoma and osteosarcoma,
as well as chondroma (3, 4). The presence of lymph node
metastasis and local invasion suggest a high-grade tumor
Although the treatment protocols vary, the main treatment
protocol is surgery (8). In low-grade tumors, while
preventing laryngeal function treatments such as CO2
laser ablation and hemilaryngectomy, total laryngectomy
is performed in patients with large tumors and high grade
(1, 8, 10). Since the chondrosarcoma is not sensitive to
radiation, the place of radiation in the treatment is limited
(7). Radiotherapy can be added to the treatment in case of
recurrence, aggressive tumors, and inoperable tumors (3).
Laryngeal chondrosarcoma has a better prognosis than
non-larynx localized chondrosarcoma and can be detected
at an earlier stage (3).
Laryngeal chondrosarcoma has a good prognosis and
rarely metastasizes (8). Metastases are to the cervical lymph
nodes, lung, bone, and liver (2, 4). However, recurrence can
be seen in 35-40% (8). Recurrence can be seen a few months
or a few years after treatment in relation to incomplete
resection and tumor grade (9). Tumor-related death is
associated with uncontrolled tumor growth, recurrence,
the presence of aggressive tumors, and tumor invasion into vital structures (5). The prognosis is better for early stage
laryngeal chondosarcomas (11).
Since laryngeal chondrosarcoma may relapse in the late
period, it requires long-term follow-up (3).
Laryngeal chondrosarcoma is a rare, low-grade tumor with
a good prognosis. This case was a chondrosarcoma located
in the thyroid cartilage, which is a rare site. Although clinical
and radiological findings are important in the diagnosis, the
definite diagnosis is based on the pathological examination.
It is especially important to differentiate the lesion from
chondromas. Adequate macroscopic sampling to evaluate
the tumor site and invasion areas clearly after macroscopic
evaluation is important in the correct diagnosis.
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