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喉软骨肉瘤:病例报告与文献综述

Laryngeal chondrosarcoma, case report and literature review.

作者信息

Hernández-Brito Carlos, Salazar-Álvarez María Alejandra, Álvarez-Bojórquez Mario Enrique, Cisneros-Juvera Francisco Carlos, López-Gómez Javier, Elizalde-Méndez Ángel, Granados-García Martín

机构信息

Department of Oncologic Surgery, National Cancer Institute, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico City, Mexico.

Department of Oncologic Surgery, National Cancer Institute, Av. San Fernando No. 22, Col. Sección XVI, C.P. 14080, Mexico City, Mexico.

出版信息

Int J Surg Case Rep. 2018;51:62-66. doi: 10.1016/j.ijscr.2018.07.041. Epub 2018 Aug 9.

Abstract

INTRODUCTION

Chondrosarcoma constitutes 0.2% of all malignant tumors of the larynx. Many surgeons treat it with total laryngectomy due to the limited experience with this neoplasm because its rarity, and although several conservative approaches have been proposed, the data of these techniques are limited and based on retrospective series.

PRESENTATION OF CASE

A 52-year-old male with a transglottic submucosal tumor and glottic stenosis in fiberoptic examination showed by tomography a laryngeal tumor that infiltrates vocal cords, glottis, cricoid and thyroid cartilage of 3 × 2.7 × 4 cm. Patient was submitted to total laryngectomy with selective bilateral neck dissection because obstructive tumor. Pathology reported a cricoid cartilage tumor consistent with grade 2 chondrosarcoma.

DISCUSSION

Biopsy by laryngoscopy is considered the standard procedure for the diagnosis of laryngeal tumors, however the need for general anesthesia and the difficulty in intubation in some patients with large tumors make difficult to obtain an adequate biopsy in some cases with submucosal tumor. Conservative surgeries should be individualized based on the size and location of the tumor as well as on the patient's general conditions. Radical treatment is recommended for high-grade and large tumors in which conservative surgery would destabilize the cricoid ring.

CONCLUSION

There is no diagnostic and treatment approach established for laryngeal chondrosarcoma, we believe that percutaneous biopsy would be the diagnostic test of choice because it is less invasive and has a high sensitivity and specificity; it could also identify patients who are candidates for conservative surgeries.

摘要

引言

软骨肉瘤占喉部所有恶性肿瘤的0.2%。由于这种肿瘤罕见,许多外科医生对其经验有限,所以多采用全喉切除术进行治疗。尽管已经提出了几种保守治疗方法,但这些技术的数据有限且基于回顾性系列研究。

病例介绍

一名52岁男性,经纤维喉镜检查发现有跨声门黏膜下肿瘤和声门狭窄,断层扫描显示喉部肿瘤浸润声带、声门、环状软骨和甲状软骨,大小为3×2.7×4厘米。因肿瘤阻塞,患者接受了全喉切除术及选择性双侧颈部淋巴结清扫术。病理报告显示环状软骨肿瘤符合2级软骨肉瘤。

讨论

喉镜活检被认为是诊断喉部肿瘤的标准程序,然而,全身麻醉的必要性以及一些大肿瘤患者插管困难,使得在某些黏膜下肿瘤病例中难以获得足够的活检样本。保守手术应根据肿瘤的大小和位置以及患者的一般状况进行个体化选择。对于高级别和大肿瘤,若保守手术会使环状软骨不稳定,则建议进行根治性治疗。

结论

目前尚无针对喉软骨肉瘤的确立的诊断和治疗方法,我们认为经皮活检将是首选的诊断测试,因为它侵入性较小,且具有高敏感性和特异性;它还可以识别适合保守手术的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c20f/6108069/b4d1c4e4800e/gr1.jpg

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