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Chondrosarcoma of Larynx

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Laryngeal chondrosarcoma is a rare low-grade tumor that pursues an indolent clinical course.

Presentation: It arises most commonly from the cricoid cartilage. Less frequently involved sites include arytenoid and thyroid cartilage or the epiglottis. It usually presents between 5th and 7th decades and affects men slightly more commonly than women. The presenting symptoms include dyspnea, hoarseness, dysphagia, odynophagia, and airway obstruction.

Imaging studies (radiograph, CT, or MRI) show an expansile lesion with "popcorn" calcifications. Invasion of adjacent soft tissue or bone is often present. Imaging cannot reliably distinguish between chondroma and chondrosarcoma. In addition, the majority of laryngeal chondrosarcomas (almost 60%) have an associated chondroma.

Grossly, the tumor is smooth, lobulated, translucent and expansile mass (as shown here) ranging in size from 1 to more than 10 cm. Microscopically, the vast majority of laryngeal chondrosarcomas are low-grade and their distinction from benign chondromas may be difficult. Chondromas are hypocellular and are composed of small mononucleated chondrocytes with normal N:C ratios, no hyperchromasia, no necrosis, and low mitotic activity. Grade 1 chondrosarcomas have bi- or multinucleated chondrocytes and may show nuclear hyperchromasia. Mitotic activity is not increased.

Treatment & Prognosis: Grade 1 laryngeal chondrosarcomas rarely metastasize. With Grade 2 and Grade 3 lesions, metastases are seen in 10% and 70% of cases respectively. Recurrence rate has been reported to range from 18% to 40%. The overall survival, regardless of the grade, is as high as 95% at 10 years. Given the excellent prognosis, conservative resection is recommended for most cases. Total laryngectomy is reserved for large bulky tumors (such as the one shown here).

Image credit: Mitchell Rad, PA (ASCP); Used with permission from American Association of Pathologists' Assistants (@PathAssist)

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