Management of tracheal chondrosarcoma almost completely obstructing the airway: a case report

Abstract

BackgroundPrimary malignant tracheal tumors account for only 0.2 % of all malignancies of the respiratory tract. Tracheal chondrosarcoma is a rare condition and only 17 cases have been described in the literature from 1965 to date. Herein we report the very unusual case of a patient with a tracheal chondrosarcoma, electively treated by curative surgery despite the virtually complete obstruction of the airway.Case presentationWe present the case of a 79-year old Caucasian man with long-lasting wheezing misdiagnosed as asthma and affected by a tracheal chondrosarcoma almost completely obstructing the airway. Videobronchoscopy and imaging investigations revealed a well-circumscribed mass arising from the cartilaginous rings of the cervical trachea with a posterior residual respiratory space of about 1 mm. Because of the mobility and flaccidity of the uninvolved pars membranacea, the tiny respiratory space slightly expanded during inspiration and expiration allowing the patient to be treated without an essential emergency procedure. Standard tracheal intubation was impossible. Rigid bronchoscopy enabled placement of a small tracheal tube distally to the tumor. Successful cervical tracheal resection and reconstruction was then performed, achieving complete tumor excision. Histologically, the mass was characterized as a low-grade tracheal chondrosarcoma. Videobronchoscopy performed 9 months after surgery showed a wide, well healed tracheal anastomosis. Ten months after surgery, the patient is alive and disease free.ConclusionComplete surgical resection is the treatment of choice for tracheal chondrosarcoma. Rigid bronchoscopy is an essential tool for diagnostic and therapeutic purposes. It allows the palliative maneuvers for obstruction relief but also, in resectable patients, the intraoperative safe and straightforward management of the obstructed airway.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-016-0498-8) contains supplementary material, which is available to authorized users.

Low-grade chondrosarcoma of the cricoid cartilage: a case report and review of the literature

“…Chondrosarcomas are more likely to cause thickening of the tracheal wall and to exhibit extraluminal extension, causing tracheal narrowing. Two cases of well-differentiated chondrosarcoma were seen with contrast-enhanced CT. On the other hand, there was no significant contrast enhancement in the case reported by Andolfi et al [25] or in the present case. Magnetic resonance imaging has no added value compared with CT and may overlook calcifications.…”

Clinical efficacy of treatment for primary tracheal tumors by flexible bronchoscopy: Airway stenosis recanalization and quality of life

“…Since delayed diagnosis and treatment may impair patient survival (10), these results suggest that clinicians should enhance their awareness of the disease. In cases of poorly controlled bronchial asthma and dyspnea, particularly those with chronic coughing and wheezing, a chest CT or bronchoscopy should be considered in order to exclude tracheal tumors (11,12). According to the different pathological manifestations, primary tracheal tumors may be divided into different grades, including benign, low-grade or highly malignant.…”

Tracheolaryngeal Squamous Cell Carcinoma with Extensive Mucosal Spread Without Metastasis in a Female

“…Tracheal tumors have been described in the literature for many years; however, they remain rare [2][3][4][5][6]. Histologically, various subtypes include but are not limited to: squamous cell carcinoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, small cell carcinoma, mucosa-associated lymphoid tissue (MALT) lymphoma, chondrosarcoma, sarcomatoid carcinoma, granular cell tumor, leiomyoma, and glomus tumor [7][8][9][10][11][12][13][14][15][16][17]. Malignant subtypes remain far more common than benign ones [7].…”