Abstract Laryngeal chondrosarcoma is a rare tumor that is known for its indolent course and its tendency to ulti- mate recurrence. According to the actually adopted classi- fication, 95% of the reported cases are of a low-grade type. A consensus recognizing conservative surgery as the most reasonable treatment for these lesions has almost been reached. However, fear of jeopardizing the patency of the laryngeal airway as a result of a wide cricoid exci- sion and also the fear of repeated recurrences could still push some surgeons to perform a total laryngectomy in the case of laryngeal chondrosarcoma. After a brief re- view of the literature, we will present five cases of laryn- geal chondrosarcoma that were treated and followed at the Clermont-Ferrand University Medical Center over the last two decades. These cases exhibit many of the clinico- pathologic features of the tumor and illustrate the pitfalls of diagnosis and treatment. In light of this presentation, we will discuss the widely accepted management as well as a newly suggested treatment modality for this disease. Keywords Laryngeal chondrosarcoma · Conservative management · Carbon dioxide laser Introduction Chondrosarcoma is the most common malignant connec- tive tissue tumor of the larynx [2, 8]. Of the cases, 95% are of low-grade malignancy and are often under-diag- nosed as benign chondromata [5, 11, 20]. The tumor is known for its indolent course, its low metastatic potential and its tendency to ultimate recurrence, an incidence sometimes regarded as an actual disease persistence [2, 5, 14]. Laryngeal chondrosarcoma almost always arises from hyaline cartilage [20]. In 68% to 87% of the cases, it arises from the cricoid cartilage, classically from the inner table of its posterior signet [5, 11, 12, 26]. The tumor can also originate in elastic cartilage, as shown in the literature by the cases reported of chondrosarcoma of the epiglottis [2, 8, 13, 20]. Typical patients are males in their 60s or 70s [20], and dyspnea with hoarseness constitutes the universal symp- tom [14, 16]. Physical examination may find a submu- cosal laryngeal mass, a vocal cord paralysis, an asymme- try of the larynx as a result of mechanical displacement of one arytenoid by the tumor or simply a narrowed subglot- tis. Biopsy is the cornerstone of the diagnosis and is par- ticularly difficult to perform, since the mucosa has to be incized and dissected bluntly before the lesion can be reached. Biopsy should be repeated until it is conclusive. Otherwise, it can be carried out by computed tomographic (CT) guide [4, 23]. CT is also eminently suitable for the assessment of this tumor [17] as it is very sensitive to the calcification present in 80% of cases [10, 14]. In 1977, Evans et al. classified chondrosarcoma of the bones into three histologic grades according to the mitotic rate, the cellularity and the nuclear size [7]. When a lesion shows a mixture of different grades, the true typing is based on the most active part [16, 27]. The histologic dif- ferentiation of low-grade chondrosarcoma from benign chondroma is not easy, and some authors advise not to un- dertake such a differentiation in the larynx at all [21]. Oth- ers consider any case of laryngeal chondroma to be suspi- cious [6]. The initial management of a cartilaginous neoplasm of the larynx should be to secure the airways whenever they are hampered. This may entail an emergent intubation or a tracheostomy [28]. As for the definitive treatment, there is actually a general consensus that conservative surgery is the most appropriate method for the low-grade lesions [12, 13, 14, 15, 16, 22, 24, 27, 28, 29]. This is supported Hazem Mohammad Ali Saleh · Christophe Guichard · Marc Russier · Jean Louis Kémény · Laurent Gilain Laryngeal chondrosarcoma: a report of five cases Eur Arch Otorhinolaryngol (2002) 259 : 211–216 © Springer-Verlag 2002 Received: 8 December 1998 / Accepted: 26 September 2001 HEAD AND NECK ONCOLOGY H. M. A. Saleh () · C. Guichard · M. Russier · J. L. Kémény · L. Gilain Department of Otorhinolaryngology and Cervicofacial Surgery, Clermont-Ferrand University Medical Center, BP 69, 63003 Clermont-Ferrand, France e-mail: saleh@montp.inserm.fr H. M. A. Saleh · C. Guichard · M. Russier · J. L. Kémény · L. Gilain Department of Pathology, Clermont-Ferrand University Medical Center, BP 69, 63003 Clermont-Ferrand, France