Chondrometaplasia
Definition and epidemiology
Etiology
Pathology
Clinical features
Diagnosis and differential diagnosis
Treatment and prognosis
Relatively common (perhaps as many as 9% of symptomatic vocal cord polyps, 1.2–1.7% at autopsy) | |
Symptomatic i.e. change in phonation (vocal cords, epiglottis, ventricle), or asymptomatic (false vocal cords) | |
Adults (average age 52 years, symptomatic patients) | |
Size usually less than 1 cm in diameter | |
Elastic cartilage; small homogeneous nuclei, no mitoses | |
Differential diagnosis—chondroma | |
Transition zone (chondroid center, spindle periphery) | |
Recurrences rare following excision, no metastatic potential |
Chondroma
Definition and epidemiology
Etiology
Pathology
Clinical features
Diagnosis and differential diagnosis
Treatment and prognosis
Rare lesions. May be less common than laryngeal chondrosarcoma, but the true incidence is difficult to judge from older reports in which the distinction from chondrometaplasia and low-grade chondrosarcoma may sometimes have been imperfect | |
Symptomatic lesions cause airway obstruction or a palpable mass in the neck | |
Usually found in the vicinity of the cricoid cartilage, thyroid cartilage, epiglottis, and arytenoids | |
May be a few cm in diameter and usually smaller than a laryngeal chondrosarcoma | |
Hyaline cartilage, small, monomorphous nuclei without significant nuclear details, no mitoses | |
No transition zone (in contrast to chondrometaplasia) | |
Differential diagnosis: chondrometaplasia, low-grade chondrosarcoma (and, most rarely, laryngeal hamartomas) | |
May recur following excision, but this is uncommon, no metastatic potential |
Chondrosarcoma
Definition and epidemiology
Chondrometaplasia | Chondroma | |
---|---|---|
Symptoms | Hoarseness or asymptomaticr | Obstruction of the airway or swelling of the neck |
Gross presentation | Small nodule < 1 cm in diameter | Multilobular tumour |
Gross presentation | Ventricular fold and vocal cord | Cricoid and thyroid cartilages |
Type of cartilage | Elastic | Hyaline (usually) |
Series | No. of cases | Period | Authors | Year | Remarks |
---|---|---|---|---|---|
University Hospital Heidelberg, Germany | 7 | 2013–2018 | Akbaba et al. [44] | 2018 | These cases were treated upfront with raster-scanned carbon ion Radiotherapy |
Johns Hopkins, School of Medicine, Baltimore, USA | 6 | 2004–2013 | Karatayli-Ozgursoy et al. [45] | 2016 | All were of cricoid origin, three out of six had a recurrence |
Guy’s and St Thomas’ NHS Foundation Trust, London, UK | 5 | 1996–2012 | Stavrakas et al. [46] | 2016 | |
Dept. of ORL, Turin, Rome, Belluno, Italy | 6 | 2006–2013 | Damiani et al. [47] | 2014 | All had conservative surgical approach |
Centro Hospitalar e Universitário de Coimbra, Portugal | 6 | 2002–2012 | Oliveira et al. [48] | 2014 | One had high grade, five underwent total laryngectomy |
Montpellier University Hospital, France | 7 | 2001–2008 | Pelliccia et al. [49] | 2014 | All had low-grade cricoid chondrosarcoma |
University of Brescia, Italy | 16 | 2001–2013 | Piazza et al. [41] | 2014 | Eleven were of low grade and five of intermediate grade |
Moffitt Cancer Institute USA | 5 | 2004–2011 | Jackson et al. [50] | 2013 | Four were of low grade and one of intermediate grade |
Tel Aviv University, Israel | 6 | 1959–2010 | Buda et al. [51] | 2012 | Recurrence developed in two patients 2 and 8 years after primary treatment |
Harvard Medical School USA | 11 | 2002–2011 | Friedman et al. [52] | 2012 |
b
|
Harvard Medical School, USA | 10 | 1995–2010 | Zeitels et al. [53] | 2011 | Eight underwent conservation function preservation surgery |
Croix-Rousse Hospital, France | 7 | 1996–2006 | Merrot et al. [54] | 2009 | All were of low grade |
Institut Gustave-Roussy France, and M. D. Anderson Cancer Center, USA | 15 | 1978–1997 | Casiraghi et al. [25] | 2004 | One was of high grade |
Wake Forest University, USA | 9 | 1991–2002 | Koufman et al. [55] | 2004 | All were cricoid and of low grade |
Armed Forces, Institute of Pathology, USA | 111 | 1970–1997 | Thompson and Gannon [22] | 2002 | Only six were of high grade |
Clermont-Ferrand University Medical Center, France | 5 | 1981–1990 | Saleh et al. [56] | 2002 | One was of high grade One was myxoid type and presented with neck metastases |
The Royal National Throat, Nose and Ear Hospital, UK | 12 | 1976–1999 | Rinaldo et al. [19] | 2000 | All were of low grade No metastases |
Armed Forces Institute of Pathology, USA | 240 | 1929–1999 | Dennis K. Heffner personal communication [23] | 1999 | This series includes the cases of Thompson and Gannon 2002a |
University Hospital VU, Amsterdam | 5 | 1980–1998 | Tiwari et al. [57] | 1999 | One of the authors previously reported four cases of chondrosarcoma of the cricoid treated from 1985 to 1995 at the same institution. No lymph node or distant metastases |
University of Kiel, Germany | 5 | 1975–1995 | Lippert et al. [58] | 1997 | One patient died of brain metastases 3 months after surgery |
Mayo Clinic, Minnesota, USA | 44 | 1910–1995 | Lewis et al. [59] | 1997 | All were of low grade. No lymph node or distant metastasesc |
University of Buenos Aires, Medical Center, Argentina | 6 | 1973–1990 | Sztern et al. [60] | 1993 | No lymph node or distant metastases |
Mallinckrodt Institute of Radiology, Washington University Medical Center, USA | 10 | –d | Wippold et al. [61] | 1993 | One was of thyroid origin, all were visible in CT scan |
Mount Sinai School of Medicine, New York City, USA | 11 | 1973–1990 | Brandwein et al. [26] | 1992 | Two cases were dedifferentiated chondrosarcoma and one presented with cervical lymph node metastases |
Depts. of ORL-HNS, Universities of Brescia (1) Padua (2) and New Haven (3) | 8 | 1983–1989 (1) 1966–1989 (2) 1962–1989 (3) | Nicolai et al. [10] | 1990 | One case was dedifferentiated chondrosarcoma and the patient presented with lung metastases |
Swedish Cancer Registry | 6 | 1958–1972 | Östberg et al. [62] | 1979 | No lymph node or distant metastases |
Chevalier Jackson Clinic, USA | 10 | 1935–1970 | Al-Saleem et al. [63] | 1970 | One patient presented with cervical lymph node metastasis |
Massachusetts Eye and Ear Infirmary, USA | 8 | 1940–1970 | Huizenga and Balogh [64] | 1970 | One patient presented with lung, kidney, and neck metastases |
Pathology
Gross pathology
Histopathology
Low-grade chondrosarcoma (grade 1 of 3) (slight increase in cellularity, nuclear size, and nuclear detail over chondroma; no or rare mitoses) | |
Intermediate-grade chondosarcoma (grade 2 of 3) (distinct increase in cellularity, nuclear size, nuclear detail, and cytological atypia over chondroma, mitoses still difficult to find) | |
High grade chondrosarcoma (grade 3 of 3) (high cellularity , easily recognized cytological atypia; mitotic figures usually readily identified; areas may be difficult to recognize as cartilaginous, owing to exceedingly high cellularity and anaplasia of tumor cells) | |
Dedifferentiated chondrosarcoma (chondrosarcoma with additional malignant mesenchymal component) (CAMMC) (low-grade chondrosarcomatous areas juxtaposed with high-grade sarcomatous area—undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma), fibrosarcoma, rhabdomyosarcoma, osteosarcoma, or sarcoma not further subclassified) | |
Chondrosarcoma with extensive myxoid change (nodules of monomorphous round to spindle cells arranged in cords, trabeculae and small clusters and set in a myxoid matrix; mitotic figures not readily identified) (note: tumors with this appearance that manifest a recipirocal t(9;22) translocation may be related to a recognized soft tissue tumor, the extraskeletal myoxid chondrosarcoma) | |
Clear cell chondrosarcoma (the tumor contains a component of balloon-like rounded cells with a predominantly clear cytoplasm and prominent nucleoli, in addition to multinucleated giant cells and bone trabeculae; the balloon-like clear cells are glycogen positive) |
Immunohistochemistry
Electronmicroscopy
Clinical features
Diagnosis and differential diagnosis
Treatment
Prognosis
Rare lesions: true incidence difficult to judge, as distinction from chondroma has not always been based on modern criteria | |
Usually arise in the vicinity of the cricoid cartilage (less often the thyroid cartilage, epiglottis, and body of the arytenoid) | |
Typically large lesions: 1–6 cm in diameter (usually larger than laryngeal chondromas) | |
Hyaline cartilage | |
Cytological features vary from barely perceptible nuclear atypia to readily apparent anaplasia (as a function of the histological type and grade of the tumor) | |
Differential-chondroma | |
Recurrence may occur following excision, may metastasize (frequency related to histological type and grade |
Chondrometaplasia | Chondroma | Chondrosarcoma | |
---|---|---|---|
Presentation | Asymptomatic or hoarseness | Dyspnea, hoarseness, mass | Dyspnea, hoarseness, mass, vocal cord paralysis, dysphagia |
Common locations | Vocal cords, epiglottis | Cricoid, thyroid cartilage, epiglottis body of the arytenoid | Cricoid, thyroid cartilage, epiglottis, body of arytenoid |
Size | Less than 1 cm | Usually 1–3 cm | Usually over 3 cm |
Fibrocartilage | Present | Absent | Absent |
Hyaline cartilage | Absent | Present | Present |
Stromal myxoid change | Absent | Absent | May be present |
Cellularity | Low | Low | Slight increase to tremendous increase |
Cytological atypia | Absent | Absent | Minimal to pronounced |
Mitotic figures | Absent | Absent | Rare to numerous |
Invasive border | Absent | Absent | Present |