2- CASE REPORT
A 56- year-old man was referred to our department with a 12-month history of dysphonia, and aggravated dyspnea during the last 2 weeks. The patient denied odynophagia or dysphagia. He was a former smoker, and he had a 50-pack-year smoking history. Flexible laryngoscopy revealed a paralysis in his right hemilarynx, with laryngeal rotation and intact mucosa (Figure 1). No lymphadenopathies were evident in the laterocervical region. CT scan and MRI revealed a submucosal expansive lesion at the right posterolateral region of the larynx, arising from cricoid cartilage, compromising the whole circumference of the cartilage, consistent with the suspicion of “cricoid chondrosarcoma ” (Figure 2). Suspicious, calcified, and oval cervical lymphadenopathies were found at level II in both sides of the neck and level III of the right side. Images did not show evidence of a mass or nodule in the thyroid gland. The patient was evaluated by the Surgical Board, and decided as a first approach, local anesthesia tracheotomy and direct laryngoscopy with biopsy. The histologic analysis showed fragments of well-differentiated hyaline cartilage, with ossification foci, consistent with “low-grade CS”.
On the basis of the histologic and radiologic findings, the case was discussed by the Oncologic Board. The decision was to perform total laryngectomy, with thyroidectomy and bilateral neck dissection.
A 4 cm chondroid pattern tumor, arising from cricoid cartilage was found, confirming the final diagnosis of a“moderately-differentiated chondrosarcoma of the cricoid cartilage” (Figure 3). PTC was detected by metastases in 12/29 lymph nodes isolated in the right neck dissection (Figure 4-5). Surgical margins were free of lesion. Vascular invasion was positive for PTC.
Postoperative course was uneventful, and the patient was discharged from our service 19 days after surgery, with swallowing function preserved. The patient was sent to Endocrinology for evaluation, and ablative treatment with radioactive iodine therapy (I-131) was scheduled. The patient was assessed every 3 months for the first year, planning a CT scan every 6 months. At 19 months follow-up the patient is free of disease and there is no clinical or imaging sign of recurrence.