The Laryngoscope Lippincott Williams & Wilkins © 2008 The American Laryngological, Rhinological and Otological Society, Inc. Chondrosarcoma of the Hyoid Bone: Imaging, Surgical, and Histopathologic Correlation Nader Saki, MD; Soheila Nik Akhlagh, MD; Neptone Emad Mostofi, MD; Khashayar Ahmadi, MD Objectives/Hypothesis: Rare diseases must be di- agnosed with great caution, so we present this case to familiarize clinicians with the presentation and treat- ment of chondrosarcoma of the hyoid bone, a rare disease. Study Design: Case report and review of the literature. Methods: We report one case of chondrosarcoma of the hyoid bone which presented with upper midline neck mass. In addition, we review the literature published in English regarding chondrosarcoma of the hyoid bone. Results: Chondrosarcoma of the hyoid bone is a rare disease of which only 14 cases have been reported until now. Patients with this disease have no sexual or racial preponderance, and most presented with a mass in the upper neck which has splotchy calcification in radiologic imaging without enhancement. The preferred treatment is wide excision. Conclusion: Because chondrosarcoma have indo- lent growth, are locally noninvasive, and appear encap- sulated during operation, they may be mistaken for a benign mass and conservatively resected. On the other hand, incomplete tumor resection may lead to recurrence, which is associated with increased risk of dedifferentia- tion and histologic grading of tumor. Surgeons should approach this surgery with caution. Key Words: Chondrosarcoma, hyoid bone, imaging, neck mass. Laryngoscope, 118:1211–1213, 2008 INTRODUCTION Although chondrosarcoma is the second most fre- quent primary malignant type of bone tumor, only 10% of chondrosarcoma occur in the head and neck region. 1–4 The hyoid bone is a rare site of origin with only 14 cases reported thus far. 4 We describe a case of chondrosarcoma of the hyoid bone. CASE REPORT A 28-year-old man presented to the otolaryngology clinic with a 3- to 4-month history of painless upper midline neck mass which had grown progressively and was not associated with dys- phagia, dyspnea, or any other upper aerodigestive or systemic symptoms (Fig. 1). Physical examination of the patient revealed a nontender, fixed, rubbery-to-hard 5- to 6-cm midline neck mass superimposed on the hyoid bone. The mass moved up and down with swallowing and moved up with extraction of the tongue. There was no lymphadenopathy. In addition, oral cavity, orophar- ynx, indirect laryngoscopy, and systemic examination were normal. Computed tomography demonstrated an ill-defined nonen- hanced mass which was associated with irregular, flocculent, and splotchy calcification and destruction of the hyoid bone (Fig. 2). We excised the tumor from the body of the hyoid bone. During the operation, the tumor appeared encapsulated and dis- section from the surrounding tissue was not difficult, but in one area, the tumor ruptured and oozed a brown gelatinous sub- stance. We sutured the rupture with 2-0 silk thread and contin- ued dissection. The tumor was adhered to the bone, and after cutting insertion of supra and infra hyoid muscle, the tumor was excised enbloc from the hyoid bone. There was no incision in the pharynx, and the patient began a liquid diet from the first day after surgery. Fortunately, there were no complications. The re- sected tumor was a 5-cm encapsulated lesion composed of lobu- lated, firm tissue. Histopathic exam revealed well differentiated chondrosarcoma (Fig. 3, 4). The patient continues to do well 21 months after surgery. However, long-term follow-up is essential, as recurrences have been reported even after 8 or 10 years. DISCUSSION Chondrosarcoma of the head and neck is relatively rare. Chondrosarcoma is used to describe a heterogeneous group of lesions with diverse morphologic features and clinical behavior, but production of neoplastic cartilage is a common feature among them. 1,2 Table I shows classifi- cations of chondrosarcoma. More than 90% of these tumors are designated con- ventional chondrosarcoma. 1 The majority of patients are older than 50 years with no racial preponderance. 1,2 The male/female ratio is controversial, and varies from equal From the Department of Otolaryngology–Head and Neck Surgery (N.S., S.N., K.A.), and the Department of Pathology (N.E.M.), Imam Khomeini Hospital, Ahwaz Jondishapour University of Medical Sciences, Iran. Editor’s Note: This Manuscript was accepted for publication Febru- ary 27, 2008. Send correspondence to Dr. Khashayar Ahmadi, Chief Resident of Otorhinolaryngology, Department of Otolaryngology–Head and Neck Sur- gery, Imam Khomeini Hospital, 24m St., Ahwaz, Iran. E-mail: dr. khashayar.ahmadi@gmail.com DOI: 10.1097/MLG.0b013e318170f8bd Laryngoscope 118: July 2008 Saki et al.: Chondrosarcoma of the Hyoid Bone 1211