Abstract
Chondrosarcomas of the larynx are rare malignancies and frequently located in cricoid cartilage. They are characterized by a low tendency to metastasis (low grade type). The treatment of choice is surgery, which may be endoscopic or open partial surgery, if extension of the cancer is limited. Prognosis is generally good. In this report, a case of low grade chondrosarcoma of the larynx is presented, which was treated surgically with a combined use of amniotic membrane and stent in airway reconstruction following laryngofissure approach for resection of the tumor.
1
Introduction
Chondrosarcomas are rare neoplasms of the larynx. They account for less than 0.2% of all laryngeal tumors. There is a male predominance with a peak incidence between fifth to eight decades .
Cricoid is the most involved cartilage. Thyroid cartilage is involved with lower frequency than cricoid. Epiglottis and arytenoid involvement is rare. Endolaryngeal surface of posterior lamina is the main location for cricoid chondrosarcoma . Histologically, chondrosarcoma divides into high grade with more malignant behavior with high tendency to metastasis and low grade type with a more benign behavior, less tendency to metastasis and better prognosis .
Dyspnea, dysphonia, stridor, neck mass and dysphagia are the most common manifestations of chondrosarcoma. These signs and symptoms are related to the size and site of tumor . Computerized tomography scanning is the modality of choice for imaging. It defines location and extension of tumor. Coarse calcification is considered diagnostic on imaging for these cartilaginous tumors . Surgery is the treatment of choice and can be varied from endoscopic or conservative open surgery to total laryngectomy, depending on the size, location and histologic grading of tumor . Reconstruction after tumor resection may be done by free flap, local flap, graft or even thyrotracheal anastomosis. In this report, we present a case of low grade chondrosarcoma resection in cricoid area with a novel technique of amniotic membrane to preserve patency of airway.
2
Case presentation
A 65-year-old female, was referred to our department with hoarseness for one year and also respiratory distress for two weeks. Indirect laryngoscopy showed left side vocal cord immobility with a mass on left aryepiglottic fold that extended to glottis and subglottic area. The mass narrowed the airway ( Fig. 1 .). Computerized tomography of neck with contrast was done to evaluate more accurate extension of laryngeal mass. It showed a 4 cm mass involving the cricoid and cricoarytenoid articulation on the left side crossing the midline, which contains some hypo and hyperdense areas in favor of lytic and sclerotic components. ( Figs. 2, 3 ) During direct microlaryngoscopy, a biopsy was taken. Histopathologic examination showed chondrocytes with cellular atypia, hyperchromatic double nuclei and pleomorphism which were in favor of a low grade chondrosarcoma ( Figs. 4, 5 ).
