Laryngeal Chondrosarcoma Research Articles

Laryngeal chondrosarcoma, a 30-year series

Introduction and objectivesLaryngeal chondrosarcoma is a rare laryngeal pathology arising from cartilaginous structures and is predominantly found in the cricoid cartilage. This study investigates its presentation, treatment modalities and patient outcomes. Patients or materials and methodsRetrospective study of laryngeal chondrosarcoma cases followed from 1992 to 2022 in the Otorhinolaryngology department of a cancer center - Instituto Português de Oncologia de Lisboa. Statistical analysis was made with Microsoft Excel® and SPSS®. ResultsWe identified 16 cases, of which two-thirds were male, with an average age of 59.6 years, and only 24% of them had a history of smoking. The commonest presentation was indolent dysphonia and/or dyspnea, and the posterior arch of the cricoid cartilage was the most affected place. Although histopathological studies after biopsy were often inconclusive, surgery emerged as the first-line of treatment for all patients. Larynx microsurgery with lesion debulking was the most frequent surgical approach (47%) followed by partial laryngectomy (24%). Neither adjuvant radiotherapy (RT) nor chemotherapy was administered in any of the cases. There was residual tumor in 23% of the cases so half of these patients were in watchful waiting while the other part underwent further microsurgery or total laryngectomy. Only one patient with recurrence received RT. Disease-specific survival rate at 1 and 5 years was 97% and 91%, respectively. ConclusionLaryngeal chondrosarcoma etiology is still unknown and is effectively treated with surgery, with a generally favorable prognosis. The main concern lies in its propensity to relapse, highlighting the importance of watchful follow-up.

Study of two Cases of Laryngeal Chondrosarcomas: Presentation, Management, And Outcomes

Laryngeal chondrosarcomas are rare malignant tumors arising in the cartilage of the larynx, posing diagnostic and therapeutic challenges. This study presents two cases treated at Ibn Sina University Hospital in Rabat, Morocco, emphasizing clinical presentations, diagnostic approaches, treatment strategies, and outcomes. Case 1 involved a 56-year-old chronic smoker presenting with inspiratory dyspnea, leading to total laryngectomy. Histopathology confirmed low-grade chondrosarcoma. Case 2 featured a 67-year-old chronic smoker with dysphonia, leading to total laryngectomy with adjuvant radiotherapy for a moderately differentiated chondrosarcoma. Imaging, endoscopy, and histopathology played crucial roles in diagnosis. The discussion outlines the rarity of laryngeal chondrosarcomas, their typical clinical manifestations, and the importance of imaging and histopathology in confirming the diagnosis. Surgical resection remains the mainstay of treatment, with considerations for partial surgery in specific cases. Radiotherapy is limited, while chemotherapy has no curative role. Prognosis correlates with histological grade and the completeness of surgical resection, with a five-year survival rate ranging from 79% to 90%. Recurrences and metastases are infrequent after complete surgery. In conclusion, a multidisciplinary approach involving oncologists, surgeons, and radiotherapists is crucial for tailored management, ensuring optimal outcomes and quality of life for laryngeal chondrosarcoma patients.

Functional or radical surgical treatment of laryngeal chondrosarcoma, analysis of survival and prognostic factors: A REFCOR and NetSarc-ResOs multicenter study of 74 cases

IntroductionLaryngeal chondrosarcoma (LCS) is a rare tumor of slow evolution whose treatment is poorly codified. For a long time, a radical treatment by total laryngectomy (TL) was proposed. More recent studies tend to propose a conservative surgical approach of the larynx. The objective of this study was to compare the overall survival (OS) of total laryngectomized patients (TL+) versus non-laryngectomized patients (TL-). The secondary objectives were to analyse the reoperation free survival (RFS), the total laryngectomy free survival (TLFS) and to identify the preoperative factors leading surgeons to propose TL. Materials and methodsA retrospective analysis of prospectively collected incident cases from the REFCOR and NetSarc-ResOs multicenter databases between March 1997 and June 2021 was conducted. A propensity score matching analysis was performed to compare the OS of TL+ and TL-patients. Results74 patients were included. After propensity score, the 5-year OS of TL+ and TL-patients was comparable (100 %, p = 1). The 5-year RFS rate was 69.2 % (95 % CI [57.5–83.4]) and the 5-year TLFS was 61.7 % (95 % CI [50.4–75.5]). Cricoid involvement greater than 50 % (HR 3.58; IC 95 % [1.61–7.92] p < 0.001), an ASA score of 3 or 4 (HR 5.07; IC 95 % [1.64–15.67] p = 0.009) and involvement of several cartilages (HR 5.26; IC 95 % [1.17–23.6] p = 0.04) are prognostic factors for TL. Dyspnea caused by the tumour is a prognostic factor for reoperation (HR 2.59; IC 95 % [1.04–6.45] p = 0.03). ConclusionThese results demonstrate that conservative treatment should be considered as first-line treatment for laryngeal chondrosarcoma.

A Case of Thyroid Chondrosarcoma

We herein report a rare case of thyroid chondrosarcoma in which laryngeal preservation surgery was performed. The patient was a man in his 40s. A hard mass was palpated on the right lateral side of the thyroid cartilage. Enhanced computed tomography showed a tumor on the right lateral side of the thyroid cartilage with partial destruction of the thyroid cartilage. Ultrasonography-guided fine-needle aspiration cytology suggested the lesion was a tumor of cartilage origin. We therefore diagnosed a thyroid cartilage tumor. We performed partial laryngectomy. Intraoperative findings revealed a hard tumor contiguous with the thyroid cartilage deep in the right omohyoid muscle. The right two-thirds of the thyroid cartilage were cut longitudinally, and the tumor was removed. The pathological diagnosis was a grade 2 chondrosarcoma of thyroid cartilage origin. Two years after surgery, there was no recurrence. There have been 37 cases of laryngeal chondrosarcoma reported in Japan, and only 8 were of thyroid cartilage origin. Surgical treatment was selected in all cases, with 16 cases treated by total laryngectomy and 21 cases by partial laryngectomy. Recurrence was reported in five cases, including local recurrence in three cases, cervical recurrence in one case, and distant metastasis in one case.

A Rare Case of Aggressive Metastatic Laryngeal Chondrosarcoma Presenting as Bilateral Necrotizing Pneumonia.

Laryngeal chondrosarcomas are rare tumors that account for only 0.2% of malignant tumors of the larynx. Approximately 80% of these tumors are low grade and well differentiated and are associated with a good long-term prognosis. Herein, we report a case of a 77-year-old male presenting with acute hypoxic respiratory failure that required intubation and mechanical ventilation. Chest CT showed multiple pulmonary nodules and cavities. He then required a tracheostomy, and a soft tissue mass in the subglottic mass was discovered. A laryngoscopy-guided excisional biopsy of the mass was performed. Histopathological examination confirmed the diagnosis of laryngeal chondrosarcoma. Clinicians should consider metastatic laryngeal chondrosarcoma as a differential diagnosis for lung cavities. Overall, we believe this to be the first case of aggressive laryngeal chondrosarcoma with mediastinal and pulmonary metastasis mimicking necrotizing pneumonia.

Imaging features of laryngeal chondrosarcomas: A case series and systematic review.

To comprehensively summarize the characteristics of radiological findings of laryngeal conventional chondrosarcomas. We included patients with pathologically proven laryngeal conventional chondrosarcomas with CT and /or MRI, including 41 cases from 31 publications recruited after a systematic review and 14 cases from our institution. Two board-certified radiologists reviewed and evaluated all the radiological images. The relationship between pathological grade and radiological findings was analyzed. The median long diameter of the lesion was 3.1 cm (range, 1.5-8.5 cm). The most common location was the cricoid (74.5%), followed by the thyroid (12.7%), cricoid and thyroid (7.3%), and arytenoid (5.5%). All lesions showed well-defined margins. Cortical defect/expansion (98.0%), internal low density (89.6%), and calcification (95.8%) with homogeneous and scarce contrast enhancement on contrast-enhanced CT (85.3%) were frequently observed. All cases showed high signal on T2-weighted imaging, low signal on T1-weighted imaging (T1WI), and heterogeneous and mild contrast enhancement on postcontrast T1WI. No significant differences were found between the pathological grades and radiological findings. In our summary of comprehensive CT and MRI findings of laryngeal conventional chondrosarcomas, we found that the knowledge of these radiological features may facilitate prompt diagnosis and appropriate management.

Primary sarcomas of the larynx: A report of three cases and literature review

Introduction. Primary sarcomas are uncommonly seen in the larynx and comprise around 1% of all laryngeal malignant tumors. We present three cases of patients with different types of laryngeal sarcomas and discuss about diagnostic and treatment difficulties. Case outline. Each patient presented with hoarseness and shortness of breath. Computed tomography scans showed large transglottic tumors of the larynx with no signs of cervical lymphadenopathy and definitive diagnoses of sarcomas were made by pathologists. Each patient underwent total laryngectomy with clear resection margins. Patient with laryngeal leiomyosarcoma developed large locoregional relapse of malignant disease and pulmonary metastasis four months after surgery and patient with laryngeal osteosarcoma was diagnosed with inoperative locoregional relapse of malignant disease three months after surgery. Both patients died within six months after surgery. On the other hand, patient with laryngeal chondrosarcoma was disease-free during the three-year follow-up. Conclusion. Primary laryngeal sarcomas have low incidence and they differ from squamous cell carcinoma by their biological characteristics and behavior. Radical surgical resection remains the mainstay of treatment with uncertain outcome due to their high potential for recurrence or metastatic spread.

Single-cell transcriptomic landscapes of a rare human laryngeal chondrosarcoma

ProposeLaryngeal chondrosarcoma is a rare non-epithelial malignant tumor. At present, the cell type composition and molecular mechanism of laryngeal chondrosarcoma have not been systematically studied.MethodsThis study focused on the histopathological and imaging features of a rare primary laryngeal chondrosarcoma in a 74-year-old male. The tumor and its paracancerous cartilage tissue were single-cell sequenced and analyzed and a total of 5455 single cells were obtained. Immunohistochemical levels were also verified.ResultsIn total five cell types were identified, including chondrocytes, myeloid cells, fibroblasts, lymphocytes, and endothelial cells. We carried out further subgroup analysis, focusing on the classification and differentiation of chondrocytes, functional enrichment analysis, and cellular communication analysis of all cell types, and explored the tumor microenvironment (TME) of laryngeal chondrosarcoma. Immunohistochemistry revealed the SLAMF9 gene was specifically expressed in non-immune cells of chondrosarcoma, but was barely expressed in the normal cartilage tissues adjacent to chondrosarcomas.ConclusionThis single-cell sequencing approach provides clues for deciphering the potential mechanisms of tumor heterogeneity and TME composition in laryngeal chondrosarcoma, and represents an important step towards the treatment of laryngeal chondrosarcoma.

The glottic-subglottic laryngectomy: Surgical technique, oncological, and functional outcomes.

The aim of this article was to describe the surgical technique and report the oncological and functional outcomes of the partial glottic-subglottic laryngectomy (GSL). A retrospective review of the clinical charts of patients who underwent GSL for laryngeal cancer from 1989 to 2020 at the Otolaryngology Unit of the Vittorio Veneto Hospital, a referral center for laryngeal cancer treatment. The present article considered 36 patients who were submitted to GSL for laryngeal cancer. The pathological exam found squamous cell carcinoma (SCC) in 16 cases, adenoid-cystic carcinoma (ACC) in 9 cases, laryngeal chondrosarcoma in 8 cases, 1 giant cell carcinoma, 1 carcinosarcoma, and 1 metastasis of colon adenocarcinoma. Considering the 16 SCC cases we observed a recurrence rate of 31%, the overall survival (OS) and disease-specific survival (DSS) were 75%. The 9 ACC cases had a recurrence rate of 23% and OS/DSS of 88%. In the 8 chondrosarcomas no relapses were reported and the OS/DSS were 100%. Among the patients without recurrence of the disease, a definitive decannulation was achieved in 21 cases (75%). The GSL represents a valid alternative to total laryngectomy in selected cases of laryngeal cancer involving the glottic and subglottic regions.

Surgical and oncological outcomes of transoral robotic total laryngectomy: A case series

ObjectiveTo evaluate the oncological, functional and voice rehabilitation outcomes of transoral robotic surgery for total laryngectomy (TORS-TL). MethodsA retrospective chart review of patients treated by TORS-TL was conducted at a single academic medical center. The following outcomes were studied: indication; average robotic set-up and operative times; mean estimated blood loss; postoperative complications; re-feeding features; mean hospital stay; need of adjuvant therapy and voice rehabilitation type. ResultsTORS-TL was performed in 10 patients for the following indications: nonfunctional larynx (N = 2); low-grade cricoid chondrosarcoma (N = 3) and recurrent laryngeal cancer after (chemo) radiation (N = 5). Two patients were excluded because the larynx was not exposable. Average robotic set-up and operative times were 20 and 278 min, respectively. The mean estimated blood loss was 50 mL. The mean hospital stay was 13.9 days (8–28 days). There was no local recurrence in patients operated for cancer recurrence (N = 5) 5 years after the surgery. Distant metastases occurred in one patient. A patient with laryngeal chondrosarcoma experienced local failure 3 years after TORS-TL. The voice rehabilitation consisted of esophageal voice (N = 2) and tracheoesophageal prosthesis (Provox®, N = 8). The main reasons for prosthesis replacement were transprosthetic (79%) and periprosthetic leaks (21%). The median lifespan of prostheses was 81 days. ConclusionTORS-TL may be a safe and effective surgical approach for selected surgical indications. Future controlled studies are needed to determine additional indications and limitations of this procedure.

Organ Preservation Strategies in Laryngeal Chondrosarcoma.

Laryngeal chondrosarcoma (LC) is a rare, slowly growing malignancy. The preferred treatment is laryngeal preservation surgery (LPS). Some patients may require multiple interventions or total laryngectomy (TL). We investigated risk factors for retreatment and TL, and assessed the impact of LPS on oncological and functional outcomes. Case series METHODS: We searched our institution database for LC. Tumor grading, localization, and margin status were tested as predictors of recurrence and organ preservation. We included 21 patients (seven females, mean age 58 ± 12 years). LPS was applied in 20 (95.2%) of them as a primary procedure. Six patients were treated by transoral approach and 14 received "open-neck" LPS. Fifteen (71.4%) were operated only once, while six patients underwent a total of 15 adjunctive procedures. Additional operations were always performed for recurrence of tumors localized within the cricoid plate. The histological grading was G1 in 81% and G2 in 19%. However, two patients with a primary G1 LC showed a G2 recurrence. Reoperations for recurrence were more frequent among patients with G2 in respect to G1 histology (83% vs. 7%, P < .001). Fifty percent of G2 LC and 8% of G1 underwent TL (P < .05). Margin status had no influence on recurrence rate. Patients with G2 LC have more recurrences requiring surgery and a higher incidence of TL. Cricoid plate localization is relevant for organ preservation. Margin status signals possible disease persistence, without influencing the need for future surgeries. Need for reoperation entails a risk of not being able to maintain organ functionality. 4 Laryngoscope, 132:838-843, 2022.

The Rare Horse behind the Hoarseness of Voice-Chondrosarcoma of Larynx.

Laryngeal chondrosarcomas are rare tumors. They usually clinically present late as they are slow growing tumors. We reported a case of laryngeal chondrosarcoma in a middle-aged male present with hoarseness of voice along with stridor. The tumor was located in subglottis with destruction of cricoid cartilage. The histopathological evaluation is particularly important as diagnosis and grading needs strict follow up of criteria.

Surgical Treatment Strategies for Laryngeal Chondrosarcomas: A Single Institution Investigation.

Laryngeal chondrosarcomas are rare malignancies with a spectrum of presentations due to varying size, local extension, and biological behavior. Moreover, these neoplasms have differing effects on respiration, phonation, and deglutition. Consequently, it is valuable to assess endoscopic and transcervical treatment strategies. Retrospective case series. A retrospective review was done from 2001 to 2020; 25 patients were identified with laryngeal chondrosarcomas. Their tumor pathology and treatment were analyzed. All 25 chondrosarcomas were in the posterior cricoid and arose in proximity to at least one cricoarytenoid joint: 23 of 25 grade I-II (low-mid), one of 25 grade II-III (mid-high), and one of 25 grade III (high). Some tumor was left in 23 of 25 to preserve cricoarytenoid-joint function. There were no known disease-specific deaths (~8-year median follow-up). Final surgical treatment in 24 of 25 was: 13 of 25 transcervical partial laryngectomy, 7 of 25 transoral-endoscopic removal, 4 of 25 total laryngectomy, and 1 of 25 observation. In this series, unresected intercurrent disease with laryngeal chondrosarcomas was not life-threatening. Therefore, disease was typically left in the posterior cricoid region to preserve mobility of at least one cricoarytenoid joint. This philosophy employed an ultra-function-sparing conservation approach that preserved and/or restored optimal voice, airway patency and swallowing. 4 Laryngoscope, 132:169-176, 2022.

Target-like chondrocytes with thick perichondrocytic rings in cartilage-forming tumours. Preliminary report.

Here we present our experience with the occurrence of neoplastic chondrocytes with target-like appearance surrounded with unusual hypertrophic thick eosinophilic perichondrocytic rings (baskets), sometimes containing two or several layers. Pericellular rings (baskets) were positive in APAS and Masson's staining method and showed immunoreactivity with antibody against type IV collagen. Such single cells or small groups of such cells were observed rarely in 3 osteochondromas, 2 skeletal chondromas, 2 extraskeletal chondromas and 2 skeletal and 1 laryngeal chondrosarcomas. Moreover, 1 unusual soft tissue chondrosarcoma was composed entirely of target-like chondrocytes with hypertrophic extremely thick perichondrocytic rings. Such cartilage-forming tumour with target-like cells, which, to the best of our knowledge, is the first such chondrosarcoma reported in the literature. Ultrastructural evidence is presented that perichondrocytic rings have complicated structure.They contained microfibrillar component with abundant admixture of irregular aggregates of dense amorphous non-fibrillar material localised in lacunar spaces. In outer part of the rings predominated microfibrillar structures corresponding to type VI collagen that produced a rather dense capsule-like demarcation line against surrounding intercellular spaces. The described unusual changes are probably the result of hyperproduction and remodelation of perichondrocytic matrix by abnormal neoplastic chondrocytes in response to unknown factors. Local vascular and molecular signals, may be supposed as probable causes of this phenomenon.

Laryngeal Chondrosarcoma Characteristics and Survival Analysis in the National Cancer Database.

To highlight various patient, tumor, diagnostic, and treatment characteristics of laryngeal chondrosarcoma (LC) as well as elucidate factors that may independently affect overall survival (OS) for LCs. Retrospective cohort study. National Cancer Database (NCDB). All LC cases from 2004 to 2016 were extracted from the NCDB. Several demographic, diagnostic, and treatment variables were compared between LC subgroups using χ2 and analysis of variance tests. Univariate and multivariate survival analyses were performed for LCs using univariate Kaplan-Meier analysis and Cox proportional hazards regression models. There were 348 LCs included in the main cohort. LCs were predominantly non-Hispanic white males with similar rates of private and government insurance (49.4% vs 45.4%). Most LCs (81.6%) underwent primary surgery, particularly partial and total laryngectomy. The 1-, 5-, and 10-year survivals for LC were 95.7%, 88.2%, and 66.3%, respectively. On multivariate analysis, lack of insurance (P = .019; hazard ratio [HR], 8.21; 95% CI, 1.40-48.03), high grade (P = .001; HR, 13.51; 95% CI, 3.08-59.26), and myxoid/dedifferentiated histological subtypes (P = .0111; HR, 10.74; 95% CI, 1.71-67.33) correlated with worse OS. No difference in OS was found between partial and total laryngectomy. This is the first multivariate survival analysis and largest single cohort study of LCs in the literature. Overall, LCs enjoy an excellent prognosis, with insurance status, grade, and histology as the main predictors of survival.

Differentiated chondrosarcoma originating in the cricoid cartilage of the larynx: evaluation and treatment. Clinical case presentation

Background Modern medicine has focused much of its activity and scientific endeavours оn the fight against malignant diseases. The goal of our clinical case presentation is to introduce the evaluation and treatment of a rare head and neck tumor, the laryngeal chondrosarcoma (CS). In such rare malignancies the end results of the treatment plan are associated with multiple cofactors that influence strongly the course of the disease. Materials and methods In our clinical case we have described the investigations and chosen tactics of treatment, applied to our patient, in a chronological manner, some immediate results, but also the long-term consequences of the management of this disease. Results In our opinion, the outcomes in this patient’s case were prompted not only by the specifics of this malignant disease, but also by the interpretation of the instrumental examination and the decisionmaking regarding the initial treatment. In addition to that, the decisions taken by the patient also play an important role in the clinical course. We want to point out that the achieved results and outcomes could be unpredictable - due to the coincidence of circumstances - and different, in comparison to the cases described in most literature. Conclusions 1. The relatively simple diagnostics with modern diagnostic methods and the abundance of options for surgical treatment or even combination therapy in complicated cases, do not create difficulties in the management of typical chondrosarcoma of the larynx. However, its treatment requires the efforts of several medical specialties - Surgery, Medical oncology, Medical imaging, Radiation therapy, Physiotherapy and Rehabilitation, Psychology and others. 2. Neither RT nor chemotherapy are recommended therapeutic options, except in some rare individual cases. 3. Conservative surgery tends to be adequate only if performed properly and timely as thus ensures long-term remission or cancerfree life. Radical surgical treatment is recommended in advanced cases.

Low Grade Laryngeal Chondrosarcoma: Clinical Presentation, Management and Short Term Outcome.

Low grade laryngeal chondrosarcomas are rare, slow growing tumors. Surgical removal of the tumor along with preservation of laryngeal function is the preferred modality of treatment. We report a case of a large low grade chondrosarcoma removed by transoral CO2 LASER surgery which had avoided an open surgery.

Laryngeal chondrosarcoma of the cricoid cartilage—a case series towards conservative management

Laryngeal chondrosarcoma of the cricoid cartilage—a case series towards conservative management

A Case of Laryngeal Chondrosarcoma in a Young Patient Treated by Laryngeal-Preserving Surgery

A Case of Laryngeal Chondrosarcoma in a Young Patient Treated by Laryngeal-Preserving Surgery

Conservative surgery for laryngeal chondrosarcoma: a review of the most recently proposed approaches.

The aim of this study was to describe the most recent technical nuances for resection and reconstruction of Grade 1 and 2 laryngeal chondrosarcomas, with a special emphasis on those located at the level of the cricoid plate, which is the site of origin of the vast majority of these rare tumours. Even though inherently based on retrospective small clinical series or anecdotal case reports, a number of studies have been recently published focusing on conservative transoral and open-neck surgical procedures aimed at an oncologically sound removal of the tumour together with organ and function preservation. The open-neck conservative approaches herein reported can be roughly distinguished in those achieving a primary airway reconstruction by a tracheo-hyoido-epiglottopexy or an end-to-end crico-tracheal, thyro-crico-tracheal or thyro-tracheal anastomosis, and those requiring a single or double-staged transposition of different microvascular flaps, with or without cartilaginous graft insertion, to reconstruct a subtotal/total cricoidectomy and obtain a rigid and stable subglottic airway. No meaningful comparison in terms of oncologic and functional outcomes is still possible among the currently available conservative surgical strategies, due to the rarity of laryngeal chondrosarcomas and the heterogeneity of treatments proposed in the literature. However, a reasonable algorithm to approach this difficult clinical entity according to its site of origin and extent of cricoid circumference involved is herein presented.