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Case Presentation

Case Presentation – July 2026 

Metastatic Laryngeal Chondrosarcoma

Written by: Esther Nelson, Student, Cleveland Clinic School of Health Professions Cytology Program, Cleveland, Ohio

Patient Age: 60-year-old male

Specimen Type: Left lower lobe lung mass, fine needle aspirate: modified Romanowsky-stained smear, Pap-stained smear, Pap-stained ThinPrep® Non-Gyn slide, and Hematoxylin and Eosin (H&E)-stained Cellient® cell block.

Patient History: Laryngeal chondrosarcoma surgically removed 1 year prior.

Cytologic Diagnosis: Positive for Malignancy. Metastatic chondrosarcoma.

Biopsy / Pathologic Diagnosis: Left Lower Lobe Biopsy- Positive. Metastatic chondrosarcoma

Case provided by: Cleveland Clinic, Cleveland, Ohio

Metastatic Laryngeal Chondrosarcoma

Etiology:

The etiology of laryngeal chondrosarcoma is unknown.1 Several hypotheses have been proposed, including disordered ossification of the hyaline cartilage of the larynx.1,2 Other possible etiologies include ischemic changes in a chondroma, post-traumatic change after repeated endotracheal intubations, or Teflon® injections.1-3

Clinical Features: 

Laryngeal chondrosarcoma presents generally between the ages of 50 to 80 years old.3 Patient gender is predominantly male, with the male to female ratio estimated as 3.2:1.1 The tumor is slow growing and presents on imaging as a smooth, lobulated mass that may or may not show calcification.1,2,4,5 Patients may be asymptomatic or symptomatic, with the most common presenting symptoms as hoarseness, dyspnea, and neck masses.2

Treatment and Prognosis:

Most laryngeal chondrosarcomas are low grade with a high survival rate.2 They are unlikely to metastasize but tend to recur if a total laryngectomy is not performed.2 The five year survival rate for laryngeal chondrosarcomas is 90% and grade, subtype, and location appear to have no impact on this rate.1 Metastasis is rare, and generally occurs when the primary mass is high grade and has been present for a long time.3 With metastases, the prognosis for the patient is poor.3 The most common site for metastasis is the lung, as seen in this case.3,4 Treatment is primarily surgical resection with a wide margin of normal tissue.1,5 Chemotherapy is not effective for treatment, most likely due to laryngeal chondrosarcomas lacking sufficient vascularization to deliver the chemotherapy into the tumor.2,3,5,6 Radiation has been used as adjuvant treatment but its effectiveness is debated. 2,3,4,5 Most research on laryngeal chondrosarcoma treatments do not include the treatment of metastases due to their rare occurrence.4 In this case, the metastasis in the left lower lobe was removed by lobectomy along with two wedges from the left upper lobe where a palpable mass was found during surgery. Adjunctive radiotherapy was utilized when further metastases were found in the right upper lung.

Cytology:

Cytology is not often performed on laryngeal chondrosarcomas, but is utilized in metastatic cases.7 The most striking feature of chondrosarcomas on cytology is the abundant basophilic matrix.1,8 The chondrocytes can be found in the lacunae of this matrix. This can be particularly helpful for diagnosing metastatic chondrosarcoma. High-grade chondrosarcoma presents with high cellularity, plump bi- or multi-nucleation, mitoses, and nucleoli.3,4,5,8

Differential Diagnoses:

Chondroma: Cytologically, chondromas look very similar to low-grade chondrosarcomas. They both display abundant stroma, bland nuclei, and low cellularity.3 Chondromas lack pleomorphism and do not cause destruction of surrounding tissues.1 Imaging can help; most chondromas are less than 3 cm in their maximum dimensions, while chondrosarcomas are often larger.3 This is the main differential for chondrosarcoma in the larynx.

Renal cell carcinoma metastases: Cytologic features can overlap between metastatic chondrosarcoma and metastatic renal cell carcinoma. This is due to the higher amount of cytoplasm, and numerous small intracytoplasmic vacuoles that can be present in both.7 The presence or absence of choroid matrix as well as clinical history are useful for differentiation.7

Chondroblastic osteosarcoma: Chondroblastic osteosarcoma also produces a matrix, and the malignant cells can be found in the lacunae. Both malignancies can show dyscohesive single cells in matrix.3,9 Clinical history is useful for differentiation as chondroblastic osteosarcoma generally occurs in younger patients while laryngeal chondrosarcoma is usually in older patients.3,9

References:

  1. Thompson L, Hernandez-Prera J, Magliocca K. Laryngeal cartilaginous tumors. In: Head and Neck Tumors. Vol 9. 5th ed. WHO Classification of Tumors Editorial Board; 2024:155-157.
  2. Chin OY, Dubal PM, Sheikh AB, et al. Laryngeal chondrosarcoma: A systematic review of 592 cases. Laryngoscope. 2017;127(2):430-439. doi:10.1002/lary.26068
  3. Baatenburg de Jong RJ, van Lent S, Hogendoorn PC. Chondroma and chondrosarcoma of the larynx. Curr Opin Otolaryngol Head Neck Surg. 2004;12(2):98-105. doi:10.1097/00020840-200404000-00008
  4. Oliveira JF, Branquinho FA, Monteiro AR, Portugal ME, Guimarães AM. Laryngeal chondrosarcoma–ten years of experience. Braz J Otorhinolaryngol. 2014;80(4):354-358. doi:10.1016/j.bjorl.2014.05.004
  5. Ferlito A, Devaney KO, Mäkitie AA. Differing characteristics of cartilaginous lesions of the larynx. Eur Arch Otorhinolaryngol. 2019;276(10):2635-2647. doi:10.1007/s00405-019-05563-w
  6. Righi S, Boffano P, Pateras D, Chiodo D, Zanardi F, Patetta R. Chondrosarcoma of the Laryngeal Thyroid Cartilage. J Craniofac Surg. 2015;26(6):e478-e479. doi:10.1097/SCS.0000000000001955
  7. Dodd LG. Fine-needle aspiration of chondrosarcoma. Diagn Cytopathol. 2006;34(6):413-418. doi:10.1002/dc.20470
  8. Thompson LD, Gannon FH. Chondrosarcoma of the larynx: a clinicopathologic study of 111 cases with a review of the literature. Am J Surg Pathol. 2002;26(7):836-851. doi:10.1097/00000478-200207000-00002
  9. VandenBussche CJ, Sathiyamoorthy S, Wakely PE Jr, Ali SZ. Chondroblastic osteosarcoma: Cytomorphologic characteristics and differential diagnosis on FNA. Cancer Cytopathol. 2016;124(7):493-500. doi:10.1002/cncy.21715

 

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