Subglottic Chondrosarcoma Presenting Only Mild Acute-Onset Dyspnea: A Case Report and Review of the Literature
A 68-year-old Asian male presented with a 1-year history of hoarseness, mild dysphagia, and a 1-month history of dyspnea. On examination, the patient had no stridor. Transnasal flexible endoscopy (fig. ) revealed a smooth mass below the glottis distorting the larynx. Half of the subglottic area was obstructed, and he also had left vocal cord paresis. A computed tomography (CT) scan of the neck revealed a solid mass in the supraglottic region, extending from the cricoid cartilage to the left thyroid cartilage area, with no neck lymphadenopathy (fig. ). The CT scan showed gross expansion of the cricoid cartilage with marked reduction of the airway, but the overlying mucosa was smooth. Some intermittent calcification spots within the extending tumor mass were also noted. On admission, the patient received laryngomicrosurgery for biopsy and tracheostomy to secure the airway. Multiple biopsies were taken which revealed features consistent with low-grade chondrosarcoma (fig. ). As the patient is running a company, he needs to talk frequently. In agreement with the patient and his family, and considering the low-grade nature of the tumor, endoscopic debulking was decided. As a result, we performed a laryngomicrosurgery operation. The subglottic lesion was debulked with electrocauterization to widen the compromised airway. Histologic diagnosis revealed a low-grade chondrosarcoma of the cricoid. The patient was well after removal of the tracheostomy tube 2 months later. During the 12-month follow-up, the lesion did not increase in size and no metastasis was detected on the CT image. The patient receives ambulatory treatment and is doing well, and transnasal flexible endoscopy revealed that his airway is relatively patent (fig. ).