November 19, 2020
A 76-year-old man with recurrence of aphonia, chronic nonproductive cough, and right vocal fold paralysis in the otolaryngology exam
Chondrosarcoma of the Cricoid Cartilage
- Background:
- Chondrosarcoma is a malignant tumor that shows extensive cartilage formation.
- It accounts for 1% of laryngeal cancers, with 80% originating from cricoid cartilage.
- The mean age at diagnosis is between 60 and 70 years, with a 3:1 male to female ratio.
- It is classified into 3 histologic grades based on cellularity, atypia, and pleomorphism. Most are detected in grades I and II, with a 5-year survival rate of 90%.
- Clinical Presentation:
- Generally presents as a slow and painless growth
- Symptoms include dysphonia, chronic nonproductive cough, dyspnea, and stridor, which are thought to occur when more than 75% of the tracheal lumen is occluded.
- Key Diagnostic Features:
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CT shows a hypodense or hyperdense, ill-defined, lobulated lesion with ring and arc calcifications (chondroid matrix).
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Fifteen percent of chondrosarcomas do not demonstrate matrix calcification.
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CT shows little to no enhancement, while heterogeneous enhancement may be seen with MRI.
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- Differential Diagnoses:
- Chondroma can be difficult to distinguish from low-grade chondrosarcoma radiographically. Size greater than 4 cm, cortical breach, and older age are more suggestive of a chondrosarcoma.
- Osteosarcoma is an expansive lytic lesion often associated with a soft tissue with or without calcifications.
- Amyloidosis appears as well-defined submucosal masses without bone destruction.
- Tracheopathia osteochondroplasia typically presents with scalloped nodular calcified opacities in the submucosa.
- Posttraumatic chondrometaplasia appears as a rounded and circumscribed mass without infiltration of the surrounding tissues.
- Laryngeal cartilage metastases are extremely rare and show cartilage destruction and heterogeneous enhancement.
- Treatment:
- Due to its low frequency, no established treatment approach for laryngeal chondrosarcoma exists. The treatment of choice is usually surgical resection.
