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Cronkite DA, Moffatt C, Tam K, Yu AC, Chhetri DK, St John M. Contemporary Surgical Approaches in Managing Laryngeal Chondrosarcoma: A Scoping Review. Laryngoscope 2025. [PMID: 39968575 DOI: 10.1002/lary.32068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 01/03/2025] [Accepted: 02/04/2025] [Indexed: 02/20/2025]
Abstract
OBJECTIVE The aim of this scoping review is to describe and evaluate current surgical management options for chondrosarcoma of the larynx, and to summarize these techniques with respect to the laryngeal subsite affected. DATA SOURCES PubMed/MEDLINE and EMBASE databases. REVIEW METHODS The review was conducted according to the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews. RESULTS Forty-one articles met eligibility criteria for inclusion in the final analysis, which included a total of 149 unique surgical cases that were analyzed based on affected laryngeal subsites of cricoid, thyroid, arytenoid, and epiglottis. Management of cricoid chondrosarcoma favored transoral endoscopic resection (TER) or transcervical laryngeal preservation surgery (TPLS), which ranged from limited tumor debulking via laryngofissure to larger operations like subtotal to total cricoidectomy with laryngeal reconstruction. Nearly all cases of arytenoid and epiglottic chondrosarcoma were successfully managed with TER techniques. Thyroid chondrosarcoma primarily affected the outer cortex of the cartilage and very rarely involved the endolaryngeal mucosa, making it very amenable to transcervical approaches to remove part of or the entire affected thyroid lamina. CONCLUSION Overall trends in the articles reviewed for this study suggest that more aggressive surgery and R0 resection did not lead to better overall survival, which aligns with the broader philosophical shift in treatment goals to prioritize preservation of the larynx and laryngeal function over complete oncologic resection. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- D Alexander Cronkite
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Clare Moffatt
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kenric Tam
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alice C Yu
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Dinesh K Chhetri
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Maie St John
- Department of Head & Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Gazda P, Baujat B, Sarini J, Gomez-Brouchet A, Philouze P, Moya-Plana A, Malard O, Fakhry N, De Mones Del Pujol E, Garrel R, Page C, Mouawad F, Vaz E, Evrard D, Bach C, Dufour X, Lelonge Y, Schultz P, Mauvais O, Brenet E, Vergez S, Atallah S. Functional or radical surgical treatment of laryngeal chondrosarcoma, analysis of survival and prognostic factors: A REFCOR and NetSarc-ResOs multicenter study of 74 cases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107315. [PMID: 38219696 DOI: 10.1016/j.ejso.2023.107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/22/2023] [Accepted: 12/03/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Laryngeal chondrosarcoma (LCS) is a rare tumor of slow evolution whose treatment is poorly codified. For a long time, a radical treatment by total laryngectomy (TL) was proposed. More recent studies tend to propose a conservative surgical approach of the larynx. The objective of this study was to compare the overall survival (OS) of total laryngectomized patients (TL+) versus non-laryngectomized patients (TL-). The secondary objectives were to analyse the reoperation free survival (RFS), the total laryngectomy free survival (TLFS) and to identify the preoperative factors leading surgeons to propose TL. MATERIALS AND METHODS A retrospective analysis of prospectively collected incident cases from the REFCOR and NetSarc-ResOs multicenter databases between March 1997 and June 2021 was conducted. A propensity score matching analysis was performed to compare the OS of TL+ and TL-patients. RESULTS 74 patients were included. After propensity score, the 5-year OS of TL+ and TL-patients was comparable (100 %, p = 1). The 5-year RFS rate was 69.2 % (95 % CI [57.5-83.4]) and the 5-year TLFS was 61.7 % (95 % CI [50.4-75.5]). Cricoid involvement greater than 50 % (HR 3.58; IC 95 % [1.61-7.92] p < 0.001), an ASA score of 3 or 4 (HR 5.07; IC 95 % [1.64-15.67] p = 0.009) and involvement of several cartilages (HR 5.26; IC 95 % [1.17-23.6] p = 0.04) are prognostic factors for TL. Dyspnea caused by the tumour is a prognostic factor for reoperation (HR 2.59; IC 95 % [1.04-6.45] p = 0.03). CONCLUSION These results demonstrate that conservative treatment should be considered as first-line treatment for laryngeal chondrosarcoma.
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Affiliation(s)
- Pierre Gazda
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse, Toulouse University Hospital, 1 Avenue Irène Joliot-Curie, 31400, Toulouse, France; Department of ENT-Head and Neck Surgery, CHU Larrey Toulouse, 24 Chemin de Pouvourville, 31400 Toulouse, France
| | - Bertrand Baujat
- Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la Chine 75020, Paris, France
| | - Jérôme Sarini
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse, Toulouse University Hospital, 1 Avenue Irène Joliot-Curie, 31400, Toulouse, France
| | - Anne Gomez-Brouchet
- Department of Pathology and Cytopathology, University Cancer Institute Toulouse, Toulouse University Hospital, 1 Avenue Irène Joliot-Curie, 31400, Toulouse, France
| | - Pierre Philouze
- Department of ENT-Head and Neck Surgery, Hospices Civils de Lyon, Lyon-Nord University Hospital, 103 Grande Rue de La Croix Rousse, 69000, Lyon, France
| | - Antoine Moya-Plana
- Department of ENT-Head and Neck Surgery, Gustave Roussy Cancer Campus, 114, Rue Edouard Vaillant, 94805, Villejuif, France
| | - Olivier Malard
- Department of ENT-Head and Neck Surgery, Nantes University Hospital, 1 Place Alexis-Ricordeau, 44000, Nantes, France
| | - Nicolas Fakhry
- Department of ENT-Head and Neck Surgery, University Hospital of Marseille, APHM, 13915, Marseille, France
| | - Erwan De Mones Del Pujol
- Department of ENT-Head and Neck Surgery, University Hospital of Bordeaux, 12 rue Dubernat 33404 Talence France
| | - Renaud Garrel
- Department of ENT-Head and Neck Surgery, University Hospital of Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Cyril Page
- Department of ENT-Head and Neck Surgery, University Hospital of Amiens, 3 Rue des Louvels, 80000 Amiens, France
| | - Francois Mouawad
- Department of ENT-Head and Neck Surgery, CANTHER "Cancer heterogeneity, Plasticity and Resistance to Therapies", UMR9020 - U1277 Inserm - Lille University - University Hospital of Lille - Oscar Lambret Center, 59037 Lille Cedex, France
| | - Emmanuelle Vaz
- Department of Pathology and Cytopathology, Tenon Hospital, APHP, 4 rue de la Chine, 75020, Paris, France
| | - Diane Evrard
- APHP, Department of ENT-Head and Neck Surgery, Bichat Hospital, 46 rue Henri-Huchard, 75018 Paris, France
| | - Christine Bach
- Departement of ENT-Head and Neck Surgery, Clinique Chirurgicale du Val D'Or, 14 Rue Pasteur, 92210 Saint-Cloud, France
| | - Xavier Dufour
- Department of ENT-Head and Neck Surgery, University Hospital of Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Yann Lelonge
- Department of ENT-Head and Neck Surgery, University Hospital of Saint-Etienne, Av. Albert Raimond, Saint-Etienne, France
| | - Philippe Schultz
- Department of ENT-Head and Neck Surgery, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Olivier Mauvais
- Department of ENT-Head and Neck Surgery, University Hospital of Besançon, France, 25000, Besançon, France
| | - Esteban Brenet
- Department of ENT-Head and Neck Surgery, Robert Debré University Hospital, 51100, Reims, France
| | - Sébastien Vergez
- Department of ENT-Head and Neck Surgery, University Cancer Institute Toulouse, Toulouse University Hospital, 1 Avenue Irène Joliot-Curie, 31400, Toulouse, France; Department of ENT-Head and Neck Surgery, CHU Larrey Toulouse, 24 Chemin de Pouvourville, 31400 Toulouse, France.
| | - Sarah Atallah
- Sorbonne University, APHP, Department of ENT-Head and Neck Surgery, Tenon Hospital, 4 rue de la Chine 75020, Paris, France
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Piazza C, Lancini D, Zigliani G, Del Bon F, Tomasoni M, Montenegro C, Rampinelli V, Mattavelli D. Hemicricoidectomy with modified rotational thyro-crico-tracheal anastomosis: a newborn in the family of crico-tracheal resection and anastomosis techniques. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:382-389. [PMID: 37814978 PMCID: PMC10773548 DOI: 10.14639/0392-100x-n2623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 10/11/2023]
Abstract
Objective The aim of the present study is to describe our novel surgical technique of hemicricoidectomy and reconstruction with modified rotational thyro-crico-tracheal anastomosis for the treatment of non-squamous cell subglottic tumours. The procedure has been defined as Type E crico-tracheal resection and anastomosis (CTRA) following the University of Brescia (C)TRA classification introduced elsewhere. Methods A detailed anatomical step-by-step dissection was reproduced and illustrated on a cadaveric laryngo-tracheal specimen. Moreover, oncological and functional outcomes of the first 5 patients who underwent Type E CTRA at our Institution between October 2016 and September 2022 are described. Results Three patients underwent Type E CTRA for cricoid chondrosarcoma (CS) and 2 patients for subglottic adenoid cystic carcinoma (ACC). No post-operative complication was reported. All patients maintained intact oral intake and an intelligible voice at discharge. All but one patient with obstructive sleep apnoea hypopnea syndrome and lung comorbidity were successfully decannulated before discharge. At the last follow-up (April 2023), one patient experienced local recurrence of CS that was still amenable to conservative treatment by transoral debulking, while the remaining patients were free of disease. Conclusions With the proper indications, Type E CTRA is a feasible and effective conservative surgical technique for selected non-squamous cell subglottic tumours.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Claudia Montenegro
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, School of Medicine, Brescia, Italy
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Rovó L, Szakács L, Castellanos PF, Tóbiás Z, Pfiszterer P, Ambrus A, Csanády M, Bach Á. Extended partial laryngectomy with functional preservation using the rotational crico-thyrotracheopexy. Laryngoscope Investig Otolaryngol 2023; 8:1328-1336. [PMID: 37899879 PMCID: PMC10601548 DOI: 10.1002/lio2.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives Glottic tumors with infiltration of the anterior/posterior commissure, and lesions with subglottic, cricoid, or cricoarytenoid joint infiltration have been highly controversial in the past, from the perspective of oncological safety. Although conservation laryngeal resection options exist, most are limited by the extent of resection proscribed by the technique and the postoperative functional results. Oncologically speaking, extended vertical hemilaryngectomy is often the optimal solution. However, limited reconstruction methods often compel total laryngectomy. Methods Eight patients with vocal fold malignancy, which infiltrated the anterior and sometimes the posterior commissure and with subglottic extension and resultant uni/bilateral vocal fold motion impairment, were treated by single stage extended vertical partial laryngectomy with rotational crico-thyrotracheopexy as a functional reconstruction of the laryngeal framework. Patients were evaluated with objective and subjective function tests. Results Histologic examination demonstrated tumor-free margins in every case. Definitive decannulation was successful in all cases within 2 weeks. All patients had a stable and adequate airway during follow-up and reported socially acceptable voice. Oral feeding was possible in seven patients. Conclusion Rotational crico-thyrotracheopexy, as a single stage reconstruction technique, is based on well-vascularized, readily available, appropriately shaped local tissues, without significant donor site morbidity or need for long-term stenting to reconstruct large laryngeal defects after extended vertical hemilaryngectomy for advanced unilateral glottic tumors and is applicable even with supra/subglottic invasion or infiltration of the contralateral vocal fold. An adequate airway can be achieved with socially acceptable voice and safe swallowing without compromising oncologic reliability. Level of Evidence 4 (retrospective case series review).
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Affiliation(s)
- László Rovó
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - László Szakács
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Paul F. Castellanos
- Division of Otolaryngology, Department of SurgerySt. Rita's Mercy HospitalLimaOhioUSA
| | - Zoltán Tóbiás
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Péter Pfiszterer
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Andrea Ambrus
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Miklós Csanády
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
| | - Ádám Bach
- Department of Otorhinolaryngology—Head and Neck Surgery, Albert Szent‐Györgyi Faculty of MedicineUniversity of SzegedSzegedHungary
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Álvarez-Calderón-Iglesias O, Pérez-Sayáns M, Hurtado-Ruzza R, Lorenzo-Pouso A, Chamorro-Petronacci C. Survival outcomes in laryngeal chondrosarcoma: a systematic review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:502-515. [PMID: 36654516 PMCID: PMC9853110 DOI: 10.14639/0392-100x-n1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 09/27/2022] [Indexed: 01/18/2023]
Abstract
Laryngeal chondrosarcomas (LCS) are rare lesions that behave as locally aggressive tumours, producing symptoms such as dysphonia, dyspnoea, dysphagia and hoarseness. Different approaches for the treatment of LCS have been described in the literature. The main purpose of this investigation was to find all cases of LCS published to date and analyse management data and survival outcomes. In December 2020, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Provider Enrollment, Chain, and Ownership System (PECOS) method including articles published up to this date on different aspects of LCS. The search included the terms larynx, laryngeal, chondrosarcoma. A total of 148 articles were included in this systematic review describing 381 cases of LCS. Dyspnoea was the most reported symptom followed by hoarseness and neck mass sensation. Cricoid cartilage was the most usual location. Survival rate was influenced by both surgical technique (log-rank = 11.7; p = 0.008) and the degree of tumour histologic differentiation (log-rank = 18.3; p = 0.003).
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Affiliation(s)
- Oscar Álvarez-Calderón-Iglesias
- Department of Health Sciences; Faculty of Nursing and Podiatry; Research, Health and Podiatry Group - Universidade da Coruña; HM Hospitals Research Foundation, Madrid, Spain
| | - Mario Pérez-Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Rafael Hurtado-Ruzza
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario de Ourense, Province of Ourense, Spain; Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
| | - Alejandro Lorenzo-Pouso
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Cintia Chamorro-Petronacci
- Oral Medicine, Oral Surgery and Implantology Unit, MedOralRes Group, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain,Correspondence Cintia Micaela Chamorro Petronacci C/ entrerrios S/N, CP: 15706, Santiago de Compostela, Spain Tel.: +34 651011815 E-mail:
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Bertolin A, Lionello M, Baldovin M, Ghirardo G, Rizzotto G. The glottic-subglottic laryngectomy: Surgical technique, oncological, and functional outcomes. J Surg Oncol 2021; 125:145-150. [PMID: 34542917 DOI: 10.1002/jso.26675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aim of this article was to describe the surgical technique and report the oncological and functional outcomes of the partial glottic-subglottic laryngectomy (GSL). METHODS A retrospective review of the clinical charts of patients who underwent GSL for laryngeal cancer from 1989 to 2020 at the Otolaryngology Unit of the Vittorio Veneto Hospital, a referral center for laryngeal cancer treatment. RESULTS The present article considered 36 patients who were submitted to GSL for laryngeal cancer. The pathological exam found squamous cell carcinoma (SCC) in 16 cases, adenoid-cystic carcinoma (ACC) in 9 cases, laryngeal chondrosarcoma in 8 cases, 1 giant cell carcinoma, 1 carcinosarcoma, and 1 metastasis of colon adenocarcinoma. Considering the 16 SCC cases we observed a recurrence rate of 31%, the overall survival (OS) and disease-specific survival (DSS) were 75%. The 9 ACC cases had a recurrence rate of 23% and OS/DSS of 88%. In the 8 chondrosarcomas no relapses were reported and the OS/DSS were 100%. Among the patients without recurrence of the disease, a definitive decannulation was achieved in 21 cases (75%). CONCLUSIONS The GSL represents a valid alternative to total laryngectomy in selected cases of laryngeal cancer involving the glottic and subglottic regions.
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Affiliation(s)
- Andy Bertolin
- AULSS2 Treviso, Otolaryngology Operative Unit, Vittorio Veneto Hospital, Vittorio, Veneto, Italy
| | - Marco Lionello
- AULSS2 Treviso, Otolaryngology Operative Unit, Vittorio Veneto Hospital, Vittorio, Veneto, Italy
| | - Maria Baldovin
- AULSS2 Treviso, Otolaryngology Operative Unit, Vittorio Veneto Hospital, Vittorio, Veneto, Italy.,Department of Neuroscience, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Guido Ghirardo
- AULSS2 Treviso, Otolaryngology Operative Unit, Vittorio Veneto Hospital, Vittorio, Veneto, Italy
| | - Giuseppe Rizzotto
- AULSS2 Treviso, Otolaryngology Operative Unit, Vittorio Veneto Hospital, Vittorio, Veneto, Italy
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Vučković L, Klisic A, Filipović A, Popović M, Ćulafić T. Low-grade chondrosarcoma of the larynx: A case report. World J Clin Cases 2021; 9:7805-7810. [PMID: 34621830 PMCID: PMC8462258 DOI: 10.12998/wjcc.v9.i26.7805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/25/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chondrosarcomas of the larynx are malignant tumours that most commonly originate from the hyaline cartilage. Chondrosarcoma of the larynx, the most common type of low-grade tumour, accounts for 1% of all laryngeal neoplasms.
CASE SUMMARY We present the case of a 60-year-old female patient who developed progressive hoarseness and shortness of breath over a 2-mo period. The patient had undergone resection of a laryngeal tumour 14 years before the aforementioned symptoms occurred, and histopathological analysis indicated that it was a chondroma. During the assessment of the patient, a submucosal, oval-shaped tumour was detected that was predominantly located on the left side of the larynx and was approximately 6 cm in size. The decision to perform left partial vertical laryngectomy was made. A pathohistological diagnosis of low-grade chondrosarcoma was made. Considering the results of pathohistological analysis and the positive margins of the resection, a total laryngectomy was performed. During the 12-mo follow-up, no local relapse or regional or distant metastases was detected.
CONCLUSION Chondrosarcoma of the larynx must be considered in the differential diagnosis of laryngeal submucosal tumours. It is crucial to carefully sample of tumour tissue, differentiate chondroma and chondrosarcoma, and consider the possibility of malignant changes from chondroma to chondrosarcoma.
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Affiliation(s)
- Ljiljana Vučković
- Clinical Center of Montenegro, Department of Pathology, University of Montenegro-Faculty of Medicine, Podgorica 81000, Montenegro
| | - Aleksandra Klisic
- Primary Health Care Center, University of Montenegro-Faculty of Medicine, Podgorica 81000, Montenegro
| | - Aleksandar Filipović
- Clinical Center of Montenegro, Department of Endocrine Surgery, University of Montenegro-Faculty of Medicine, Podgorica 81000, Montenegro
| | - Mirko Popović
- Clinical Center of Montenegro, Clinic for Otorhinolaryngology and Maxillofacial Surgery, University of Montenegro-Faculty of Medicine, Podgorica 81000, Montenegro
| | - Tatjana Ćulafić
- Department of Pathology, Clinical Center of Montenegro, Podgorica 81000, Montenegro
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Rüller K, Sittel C, Kölmel JC, Burghartz M, Steimer J, Fiz F, Piazza C, Peretti G, Fiz I. Organ Preservation Strategies in Laryngeal Chondrosarcoma. Laryngoscope 2021; 132:838-843. [PMID: 34418107 DOI: 10.1002/lary.29826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngeal chondrosarcoma (LC) is a rare, slowly growing malignancy. The preferred treatment is laryngeal preservation surgery (LPS). Some patients may require multiple interventions or total laryngectomy (TL). We investigated risk factors for retreatment and TL, and assessed the impact of LPS on oncological and functional outcomes. STUDY DESIGN Case series METHODS: We searched our institution database for LC. Tumor grading, localization, and margin status were tested as predictors of recurrence and organ preservation. RESULTS We included 21 patients (seven females, mean age 58 ± 12 years). LPS was applied in 20 (95.2%) of them as a primary procedure. Six patients were treated by transoral approach and 14 received "open-neck" LPS. Fifteen (71.4%) were operated only once, while six patients underwent a total of 15 adjunctive procedures. Additional operations were always performed for recurrence of tumors localized within the cricoid plate. The histological grading was G1 in 81% and G2 in 19%. However, two patients with a primary G1 LC showed a G2 recurrence. Reoperations for recurrence were more frequent among patients with G2 in respect to G1 histology (83% vs. 7%, P < .001). Fifty percent of G2 LC and 8% of G1 underwent TL (P < .05). Margin status had no influence on recurrence rate. CONCLUSIONS Patients with G2 LC have more recurrences requiring surgery and a higher incidence of TL. Cricoid plate localization is relevant for organ preservation. Margin status signals possible disease persistence, without influencing the need for future surgeries. Need for reoperation entails a risk of not being able to maintain organ functionality. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Karina Rüller
- Department of Otorhinolaryngology - Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Christian Sittel
- Department of Otorhinolaryngology - Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Jan-Constantin Kölmel
- Department of Otorhinolaryngology - Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Marc Burghartz
- Department of Otorhinolaryngology - Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Steimer
- Department of Otorhinolaryngology - Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Francesco Fiz
- Department of Radiology, Nuclear Medicine Unit, University of Tübingen, Tübingen, Germany
| | - Cesare Piazza
- Department of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Ivana Fiz
- Department of Otorhinolaryngology, G. Gaslini Children's Hospital, Genoa, Italy
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Zeitels SM, Baird BJ. Surgical Treatment Strategies for Laryngeal Chondrosarcomas: A Single Institution Investigation. Laryngoscope 2021; 132:169-176. [PMID: 34291467 DOI: 10.1002/lary.29762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/15/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngeal chondrosarcomas are rare malignancies with a spectrum of presentations due to varying size, local extension, and biological behavior. Moreover, these neoplasms have differing effects on respiration, phonation, and deglutition. Consequently, it is valuable to assess endoscopic and transcervical treatment strategies. STUDY DESIGN Retrospective case series. METHODS A retrospective review was done from 2001 to 2020; 25 patients were identified with laryngeal chondrosarcomas. Their tumor pathology and treatment were analyzed. RESULTS All 25 chondrosarcomas were in the posterior cricoid and arose in proximity to at least one cricoarytenoid joint: 23 of 25 grade I-II (low-mid), one of 25 grade II-III (mid-high), and one of 25 grade III (high). Some tumor was left in 23 of 25 to preserve cricoarytenoid-joint function. There were no known disease-specific deaths (~8-year median follow-up). Final surgical treatment in 24 of 25 was: 13 of 25 transcervical partial laryngectomy, 7 of 25 transoral-endoscopic removal, 4 of 25 total laryngectomy, and 1 of 25 observation. CONCLUSIONS In this series, unresected intercurrent disease with laryngeal chondrosarcomas was not life-threatening. Therefore, disease was typically left in the posterior cricoid region to preserve mobility of at least one cricoarytenoid joint. This philosophy employed an ultra-function-sparing conservation approach that preserved and/or restored optimal voice, airway patency and swallowing. LEVEL OF EVIDENCE 4, Case series Laryngoscope, 2021.
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Affiliation(s)
- Steven M Zeitels
- Department of Surgery-Harvard Medical School, Division of Laryngeal Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Brandon J Baird
- Department of Surgery, University of Chicago, Section of Otolaryngology-Head and Neck Surgery, Chicago, Illinois, U.S.A
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