Chondrosarcoma of Larynx

Lawrence E. Ginsberg, MD

Key Facts

Terminology

CSa, larynx: Cartilage-producing chondrocytic neoplasm with cellular atypia, bone destruction, or local invasion

Imaging

Expansile mass within laryngeal cartilage with intact mucosal surfaces, arc or ring-like Ca++
Most arise in cricoid > thyroid cartilage
CT: Ring-like or “popcorn” calcifications in expansile intracartilage mass
- Not all tumors are calcified
- Noncalcific component of mass hypodense to muscle
- Cartilage/bone destruction or local invasion seen in aggressive lesions
MR: Hyperintense mass, best seen with T2 FS, STIR
- T1WI C+: Heterogeneous enhancement

Top Differential Diagnoses

Chondroma
- Cannot be reliably differentiated from CSa with imaging; particularly noncalcified lesions
Other sarcomas: Osteosarcoma bone forming
- Synovial cell sarcoma, fibrosarcoma, malignant fibrous histiocytoma: No matrix

Pathology

Arise from hyaline cartilage: Cricoid (72%), thyroid (20%), and, very rarely, arytenoid cartilage
CSa of elastic cartilage (epiglottis) exceedingly rare

Clinical Issues

Dysphagia or palpable neck mass (with exophytic growth pattern), dysphonia, stridor
Symptoms often present for long duration, suggesting indolent process

(Left) Axial CECT in a 55-year-old woman with hoarseness shows a predominantly hypodense chondrosarcoma

arising from the left cricoid cartilage with internal calcifications

. (Right) Axial bone CT in the same patient shows more clearly the multiple internal calcifications

within the chondrosarcoma. Laryngeal chondrosarcoma arises from the cricoid cartilage approximately 70% of the time.

(Left) Axial T2 fat-saturated MR in the same patient shows CSa as a hyperintense mass

impinging on the subglottic lumen

. Lack of heterogeneity is surprising given the CT evidence of intramural calcifications. (Right) Axial bone CT in a different patient shows a noncalcified low-grade CSa

. In such a case, imaging cannot differentiate chondrosarcoma and benign chondroma. Note the tracheostomy apparatus

, necessitated by airway compromise

caused by the tumor.

TERMINOLOGY

Abbreviations

Chondrosarcoma (CSa)

Definitions

CSa, larynx: Cartilage-producing chondrocytic neoplasm with cellular atypia, bone destruction, or local invasion

IMAGING

General Features

Best diagnostic clue
- Expansile mass arising within laryngeal cartilage with intact mucosal surfaces, arc or ring-like calcification
Location
- In larynx, most arise in cricoid (posterior or posterolateral) > thyroid cartilage (inferolateral)
  - Cricoid cartilage: 72%, thyroid cartilage: 20%
- Rare in arytenoid cartilage or epiglottis
- Typically subglottic in location
Size
- 1-6 cm
- Often large at presentation if airway is spared
  - Tumor growing away from laryngeal lumen
Morphology
- Bulky, lobular mass
- Chondroid matrix typical

Radiographic Findings

Radiography
- Mass of variable density may be exophytic from laryngeal cartilage or grow inward thereby narrowing the laryngeal air column
- Stippled calcifications

CT Findings