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.