Osteosarcoma of the soft tissue of the larynx: Report of a case with electron microscopic studies

CASE REPORT A 65-year-old retired man first came to us in October 1984, reporting dyspnea of 2 months duration. The patient had for several years had Paget's disease and hypertension treated by diuretics. He also had a 25-pack/month history of cigarette smoking, having quit in 1980. The onset of his laryngeal trouble began the same year, with progressive dyspnea and dysphonia. A biopsy of a tumor originating in the right vocal cord was then performed; tissue diagnosis revealed papillomata. On admission, an indirect laryngoscopy revealed a large mass in the anterior commissure, almost obstructing the air­ way. There were no cervical nodes. Radiologic studies and direct laryngoscopy showed a 1.5-cm diameter polypoid tu­ mor, overlayed by smooth mucosa and involving the right vocal cord, with an extension to the anterior commissure and subglottic area. Esophagoscopy demonstrated no intrinsic esophageal lesion and the chest film revealed no pulmonary infiltrate. No distant metastases (bone, liver) were detected. Therefore the clinical impression was that of a benign mass of the larynx, with partial airway obstruction and without major dysphonia. In October 1984, with the patient under general anesthesia, a tracheostomy was first performed, then a thyrotomy to resect a white mass attached to the anterior commissure and both true vocal cords. The first impression of benign tumor was