Laryngeal Chondroma: A Rare Diagnosis in This Localization

Primary chondroid tumors of the larynx represent less than 1% of all laryngeal tumors. Most of them are chondromas and they often involve to the cricoid cartilage. A 31-year-old male patient applied to the oto-laryngology service with a history of dysphonia and dyspnea. Microlaryngoscopy revealed 2 cm sized, ill-defined, covered with regular mucosa, porous, and hard mass on posterior surface of crycoid cartilage in subglottic area. Following the excision of the lesion, histopathologic examination revealed as chondroma. Two years later, local recurrence was detected and the diagnosis was again chondroma. There was no complaint of the patient in last 3 and half years of follow-up. Chondroma should carefully be differentiated from chondrosarcoma and the patients should be followed for possible recurrences.

The incidence of malignancy for chondroid tumors is higher in old patients. However chondromas were seen in 10year younger patients than chondrosarcomas. Male : female ratio is 1 : 4 [7][8][9][10][11]. Although there is no definitive etiologic factor for these tumors, most commonly known is irregular ossification of the laryngeal cartilage [9][10][11][12]. Other etiologic factors are radiotherapy and teflon injection [10]. Macroscopic and microscopic appearances of laryngeal chondromas are similar to chondromas of other sites.

Clinical Features and First Operation.
A 31-years-old male patient was referred to the Chest Medicine Department with a history of dysphonia and dyspnea. Laryngeal subglottic mass was detected with bronchoscopic evaluation. The patient was consulted to the Department of Otolaryngology. 2 cm sized, ill-defined, porous, and hard mass on posterior surface of cricoid cartilage in subglottic area was detected in microlaryngoscopic evaluation. This mass was covered by regular mucosa. This lesion was scraped from posterior wall of cricoid cartilage with sickle scalpel. Mitomycine was applied to the lesion locally to prevent the development of postoperative scar. Clinically tracheostomy was not required and no complication was seen. He was discharged next day.

Pathologic Findings.
Macroscopically total volume of 2 cc, 0.2-0.5 cm sized, fragmented, gray-pink colored, medium-hardness, homogenous materials were seen. Microscopically well-defined, lobulated-contoured mass was seen 2 Case Reports in Pathology  near of the focally calcified cartilaginous tissue (Figure 1). The tumor was very hypocellular and homogenous. Tumor cells were monotone and had small oval-round nuclei. Mostly 20 nuclei were counted in one HPF. Mitosis, necrosis, hemorrhage, and binucleation were not detected ( Figure 2). The patient was diagnosed as "Laryngeal chondroma" with these morphologic findings.

Second Operation and Clinical Follow-Up.
This patient was referred to the Department of Otolaryngology with stuck feeling in the throat after 2 years from first operation. 1 × 0.8 cm sized, hard, gray-coloured mass, which is covered by regular mucosa, was detected in same localization (right subglottic area). Second microlaryngoscopy was applied and the lesion was excised in november 2007. This lesion was diagnosed as "laryngeal chondroma" too. In routine followsup no complaints and lesion were detected (42 months).
Chondroid tumors of larynx can be easily recognized histologically, because of their characteristic features. But morphologic features must be well known for differential diagnosis between subtypes.
Increased cellularity (more than 40 nuclei/HPF), nuclear atypia, binucleation, mitosis, and pleomorphism are variable in low-and high-grade chondrosarcomas. Our lesion was characterized by hypocellularity, no nuclear atypia, mitosis, binucleation, and pleomorphism. We diagnosed this lesion as "laryngeal chondroma" with these morphologic findings. Our patient referred to the Department of Otolaryngology with recurrent mass in same localization after 2 years. Microlaryngoscopic resection of lesion was diagnosed as "chondroma" too. Routine follows-up (42 months) of patient have been normal.
Chondromas are rare mesenchymal tumors of larynx. They are benign lesions but incidence of locally recurrence is very high. Histopathologicly, differential diagnosis of laryngeal chondromas should be planned very carefully. Especially differential diagnosis between chondromas and low-grade chondrosarcomas is important for planning of treatment.
Laryngeal chondroma was described in a few numbers of reports.
We suggested that the differential diagnosis of chondromas must be done carefully and the follows-up of patients must be planned more frequently. Our case had typical clinical, histopathological, and prognostic features of laryngeal chondromas.