Abstract
We report a case of chondrosarcoma of the larynx, diagnosed by a percutaneous core-needle biopsy (CNB). Cartilaginous tumors of the larynx are usually diagnosed by biopsy with direct laryngomicroscopy under general anesthesia. However, patients find it difficult to undergo a biopsy under general anesthesia, for physical, economic, and social reasons. Instead, we can readily detect and sample tumors of the larynx using ultrasound under local anesthesia with reduced stress. Concerning needle-puncture biopsies, including fine-needle aspiration cytology (FNAC) and CNB, some studies have reported needle track dissemination, a possible complication in patients with malignant tumors. Thus, in the head and neck region, we generally use FNAC for biopsies, not CNB. However, it can be difficult to diagnose bone tumors by cytology alone. Regarding primary bone tumors, only one study has reported needle track dissemination by CNB, in osteosarcoma of the femur. Additionally, this complication has not been reported before with chondrosarcoma anywhere in the body. To our knowledge, this is the first report concerning chondrosarcoma of the larynx diagnosed by percutaneous CNB. We recommend CNB as a useful and safe diagnostic technique for primary bone tumors in the head and neck region.
1
Introduction
Chondrosarcoma of the larynx is rare, accounting for less than 0.2% of all head and neck tumors and up to 1% of all laryngeal malignancies . However, considering the body as a whole, chondrosarcoma is relatively common, representing 10%–20% of all malignant primary bone tumors .
Similar to other primary bone tumors, the diagnosis of chondrosarcoma relies heavily on the correlation of clinical, radiological, and pathological information. Concerning the pathological diagnosis, at least one of the following methods is typically used: fine-needle aspiration cytology (FNAC), core-needle biopsy (CNB), and open biopsy. Although FNAC is the least invasive method, the pathological accuracy of the technique for bone tumors is inadequate due to the cytological features and nature of such lesions .
Many positive findings have been reported regarding CNB in the diagnosis of bone tumors . Thus, in the field of orthopedics, CNB is the typically the primary diagnostic method for primary bone tumors. However, there has been no previous report concerning chondrosarcoma of the larynx diagnosed by CNB. To avoid needle track dissemination, a known complication of CNB, this technique is generally not used in the head and neck region.
Here, we report a case of chondrosarcoma of the larynx diagnosed by ultrasound-guided percutaneous CNB. We discuss the utility and safety of the method.
2
Case report
A 60-year-old female presented to the Department of Respiratory Medicine at our hospital with a 1-year history of slowly increasing dyspnea and hoarseness. She had been treated for bronchial asthma for 1 year at another hospital. On x-ray ( Fig. 1 ), a huge mass in the upper airway was revealed and the patient was referred to our department. Flexible endoscopy of the larynx showed a large, left-sided bulging of the intact subglottic mucosa, occupying most of the tracheal lumen ( Fig. 2 ). Initially, a tracheostomy was performed. A neck computed tomography (CT) scan with contrast medium showed a 21 × 21 × 32-mm mass arising from the left side of the cricoid cartilage, extending beyond the midline, with invasion of the thyroid cartilage ( Fig. 3 A, B ). The scan excluded enlarged lymph nodes of the neck.
A percutaneous CNB of the mass, guided by ultrasound, was performed using a disposable needle (18 gauge) and syringe (10 mL). Two days after the biopsy, the histological examination revealed a grade I chondrosarcoma.
The patient underwent a total laryngectomy because the tumor extended beyond the midline of the cricoid cartilage. Histological examination confirmed the diagnosis of grade I chondrosarcoma of the larynx. At 2½ years after surgery, there was no evidence of recurrence.
2
Case report
A 60-year-old female presented to the Department of Respiratory Medicine at our hospital with a 1-year history of slowly increasing dyspnea and hoarseness. She had been treated for bronchial asthma for 1 year at another hospital. On x-ray ( Fig. 1 ), a huge mass in the upper airway was revealed and the patient was referred to our department. Flexible endoscopy of the larynx showed a large, left-sided bulging of the intact subglottic mucosa, occupying most of the tracheal lumen ( Fig. 2 ). Initially, a tracheostomy was performed. A neck computed tomography (CT) scan with contrast medium showed a 21 × 21 × 32-mm mass arising from the left side of the cricoid cartilage, extending beyond the midline, with invasion of the thyroid cartilage ( Fig. 3 A, B ). The scan excluded enlarged lymph nodes of the neck.
