A case of osteosarcoma arising in the soft tissue of the larynx in an elderly man is presented with light and electron microscopic documentation. The patient developed chronic hoarseness and a recurring polypoid laryngeal tumor, causing acute airway obstruction. He was treated by total laryngectomy, but he died with multiple pulmonary metastases within three months of laryngectomy. This is the third (or possibly fourth) recorded case of osteosarcoma arising in the soft tissues of the larynx, and the previous cases were clinically and pathologically similar to this one. The prognosis of sarcoma of the larynx is poor but may be improved with early recognition and adequate surgical excision.Cancer 42:2343-2351, 1978.ARCOMAS OF THE LARYNX a r e relatively S uncommon. They have been estimated to comprise between 0.32%13 a n d 1 or 2%2,3310 of all laryngeal neoplasms. Batsakis a n d Fox state that less than half of the nonepithelial lesions of the larynx are malignant. Based o n the frequency of reported cases, fibrosarcoma and chondrosarcoma a r e the most frequent primary sarcomas in the larynx, a n d most of the others are examples of lymphosarcoma a n d angiosarcoma. T h e r e a r e two accepted cases of primary osteosarcoma of the l a r y n~'~,~~ and a third case which may be a primary osteosarcoma.'j This report describes an osteosarcoma arising in the soft tissue of the larynx.
CASE REPORTA 79-year-old white male retired farmer was first seen at Parkland Memorial Hospital by the Otolaryngology Department on November 15, 1976 complaining of recurrent hoarseness, a sensation of "a lump in the throat," and marked difficulty breathing. He noted the onset of the first two symptoms in March 1976 and had undergone four previous laryngeal biopsies for what was reported to be a pyogenic granuloma. The last biopsy was performed three weeks prior to admission to Parkland Memorial Hospital. The patient had known cardiac disease with exertional angina and ischemic electrocardiographic changes, adult onset diabetes mellitus of unknown duration, and hypertension, treated by diuretics since 1969.The patient had a 40 pack-year history of cigarette smoking, having quit smoking in 1960. There was no known exposure to asbestos, toxic fumes or other carcinogenic substances.On admission his blood pressure was 172/92, pulse 84 and respiratory rate 20. The patient was alert and cooperative. There was no cervical lymphadenopathy and the trachea was in the midline. The chest was clear to percussion and auscultation; breath sounds were decreased. Cardiac examination showed a Grade III/VI holosystolic murmur, and roentgenogram of the chest showed mild cardiomegaly .The day following admission, the patient developed acute airway obstruction and tracheostomy was performed (Fig. 1). Direct laryngoscopy on the fourth day of hospitalization showed an exophytic mass covered by mucosa at the anterior commissure with involvement of the immediate infraglottic area, more so on the right than the left. The bulk of the mass was removed from the righ...
