Chondrosarcoma of nose and paranasal sinus - a rare presentation

Chondrosarcoma, the most malignant cartilageneous tumor, constitute only 4% of non-epithelial tumours of the nasal cavity, paranasal sinuses and nasopharynx, making it one of the rarest malignancies. Here we present a case of Grade 1 chondrosarcoma involving nose, maxillary sinus, ethmoids and sphenoid sinus managed surgically by wide excision. 12 months follow-up reveled no recurrence or complication.     

Perception of survival/laryngeal preservation trade-off in advanced T-stage laryngeal cancer

ObjectivesTo evaluate the perception of the survival/laryngeal preservation trade-off in advanced T-stage laryngeal cancer.Material and methodsThe Cochrane, PubMed, Embase, and Science Direct databases were searched using the keywords “cancer, neoplasms, trade-off. One hundred and eighty four articles were found; 176 of these, without data in the Abstract documenting the survival/laryngeal preservation trade-off for advanced T-stage laryngeal cancer, were excluded. Eight articles, totaling 1,052 interviewees, were read to document modalities of evaluation, trade-off thresholds, and variables influencing the perception of trade-off.ResultsEvaluation of trade-off was based on responses in group discussions, interviews and questionnaires and on patient file analysis. One study reported that 28.2% of respondents could not make a decision between options, and in 4 studies 22% to 80% of respondents would not consider jeopardizing survival. A mean 2–3 year gain (range, 6 months to 5 years) in survival was required before preferring total laryngectomy to chemoradiotherapy. The percentage loss of disease-free survival tolerated by respondents who would consider a trade-off to preserve the larynx ranged from 5% to 100%, for a median 30%. Variables influencing trade-off comprised respondent status (patient/healthcare provider/healthy subject) and characteristics (job, having children) and treatment data (amount and modalities of information delivered, survival estimates after radiation therapy, health status after treatment). A time for reflection after diagnosis and good quality information were important for respondents.ConclusionSeveral consequences emerge from these data. The first is to consider induction chemotherapy, to give the patient time to make an informed choice. The second is to not to give up teaching total laryngectomy The third is to determine whether the team's own results match the information delivered to patients.     

原发性喉软骨肉瘤临床病理分析

目的研究喉软骨肉瘤的临床病理学特征、治疗及转归。方法对3例原发性喉软骨肉瘤临床病理资料进行回顾性分析。3例均为男性,年龄52～67岁,平均60.6岁,病程2～10个月,1例患者有长期吸烟史。肿瘤均有喉外侵犯,未发现颈淋巴结肿大和远处转移。术中冰冻切片检查诊断为软骨肉瘤,均行喉全切除术,未行颈淋巴结清扫。术后病理与冰冻结果一致。术后未行放、化疗。结果3例患者分别随访18、23、50个月,复查喉部CT均无瘤生存。结论喉全切除对较大喉软骨肉瘤具有较好疗效。     

Chondrosarcoma of the larynx

Summary Chondrosarcoma of the larynx is a rare, slow-growing malignant tumor. One hundred and fifty cases of this entity have been reported in the literature. In 75% of cases the site of involvement was the cricoid cartilage, while 20% have involved the thyroid cartilage. The tumor presents as a space-occupying lesion in the subglottic region, or as a neck mass. An insidious, slowly progressing disease course associated with hoarseness and dyspnea accounts for usual delays in arriving at a diagnosis. We report our experiences with six cases of this entity and discuss a diagnostic and therapeutic approach. Whenever possible a conservative surgical management should be attempted.     

肩胛舌骨肌瓣修复喉部分切除术后缺损

目的：探讨肩胛舌骨肌瓣修复喉部分切除术后缺损的可行性和临床疗效。方法：对24例声门上型、声门型喉癌患者切除肿瘤和受累的软骨，以肩胛舌骨肌瓣修复组织缺损、重建声门。对于一侧杓状软骨固定患者，切除杓状软骨，在取肩胛舌骨肌瓣同时连带切取一小块舌骨，将小舌骨块固定于杓状软骨缺损处，用残余黏膜覆盖之。声门上型T2、声门型T3以上患者术后接受放射治疗(50～60Gy)。结果：随访1～5年，1例声门上型(T3)患者于术后2年9个月死于局部复发，1例声门型(T3)患者于术后4年3个月死于颈部转移和骨转移。拔管率为95．8％。91．7％的患者发声近乎正常或声哑。吞咽功能全部恢复。结论：经过仔细选择病例，肩胛舌骨肌瓣修复喉部分切除术后缺损、重建声门是积极有效和切实可行的。     

Recurrence of a laryngeal spindle cell sarcoma with a transformation into a higher grade of malignancy

Primary malignant mesenchymal neoplasms of the larynx are rare. Sarcomas of the larynx account for <1% of all malignant laryngeal mesenchymal neoplasms. This report examines a case of a recurring laryngeal, initial benign-appearing mesenchymal tumour, which first changed its clinical phenotype without any histological signs of malignancy and later also its histological appearance with signs of malignancy. Finally, it even underwent a transformation into a higher grade of malignancy. In addition to this, the difficulties of allocating this tumour to the correct sarcoma subentity are shown.     

Chondrosarcoma of the cervical vertebra: a case report

Summary A rare case of cervical chondrosarcoma is presented and its clinical behavior and treatment modalities are discussed.     

Primary total laryngectomy and pharyngolaryngectomy in T4 pharyngolaryngeal cancers: Oncologic and functional results and prognostic factors

Objectives

The aims of this study were to assess oncologic and functional outcome in primary total laryngectomy or pharyngolaryngectomy (TL/TL/TPL) for laryngeal or hypopharyngeal cancer with extra-laryngeal extension (T4) and to determine the predictive factors of these results.

Chondrosarcoma of the nasal septum

Chondrosarcoma of the head and neck region are relatively uncommon, arising rarely in the naval septum. The reported cases of nasal septal chondrosarcomas are extensive lesions with involvement of paranasal sinuses, orbit or skull base at the lime of diagnosis. Those limited to the nasal cavity is extremely rare and to date there has been one case report in English language literature. We present a case of chondrosarcoma of the nasal septum with involvement of the nasal cavity alone and no evidence of bony erosion. Initial multiple biopsies showed mature chondromatous areas with no atypia. The patient had wide excision of the tumour. The final biopsy of the excised specimen revealed foci of well-differentiated chondrosarcoma. Wide surgical excision with adequate margins should be considered as the treatment of choice in lesion of nasal septum even if initial biopsies are negative for malignancy. Hence this case report.     

Chondrosarcoma premaxilla

We present a very unique case of a premaxillary chondrosarcoma arising in a relatively ‘younger’ female with apparently much ‘better’ disease free 7-year survival. The literature has been reviewed and a meaningful discussion regarding diagnosis and treatment is highlighted.     

Chondrosarcoma of the temporal bone

Chondrosarcoma of the temporal bone is a rare disease, with only 36 cases of this tumor having been reported in the English language literature. We report the case of a 52-year-old woman with myxoid chondrosarcoma of the temporal bone whose only symptom was progressive hearing loss. The tumor was removed using aspiration, mastoidectomy and tympanotomy, with retention of the jugular bulb. No recurrence has been noted 45 months after the operation. Diagnosis was established from histological examination of the surgical specimens. The clinical characteristics and management of this rare lesion are discussed.     

Sex-related quality of life after total laryngectomy for cancer

ObjectivesAnalysis of the quality of sexual life after total laryngectomy (TL) for cancer.Material and methodsThe Cochrane, PubMed, Embase, ClinicalKey and Science Direct databases were searched using the keywords: “total laryngectomy, sexual function, sexual behavior, sexual complications, sexual dysfunction, sexuality, intimacy”. The abstracts of 69 articles were read by two of the authors and 24 articles were selected. The main endpoint was the impact of impairment of quality of sexual life after TL for cancer and the methods used to assess this. The secondary endpoints were the type of sexual impairment, associated variables and their treatment.ResultsThe study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.49. One of the 7 validated Likert scales was used in 79% of the articles to evaluate impairment of sexual quality of life. Impaired quality of sexual life was reported by 47% of patients on average (range, 5–90%). Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area.ConclusionThe quality of sexual life is severely impacted by TL for cancer. The present data are a source of information and should be taken into account before carrying out TL. A common information tool needs to be developed. There is patient demand for improved management of sexuality.     

喉全切除术在治疗中晚期喉癌中的应用

目的:探讨喉全切除术治疗中、晚期喉癌的疗效。方法:对573例喉癌患者行喉全切除术,声门上型370例,声门型90例,跨声门型75例,声门下型21例,放疗后复发17例。其中143例行单纯喉全切除术,430例同期行颈廓清术(单侧239例,双侧191例)。在喉全切除术中行气管外口造大孔术,共308例。结果:3、5及10年生存率分别为69.5%(398/573),61.1%(350/573),46.3%(149/322);220例死亡病例中,45.0%(99/220)死于局部复发;22.3%(49/220)死于颈部转移。术腔感染和咽瘘的发生率分别为12.2%,5.2%。16.6%气管外口造大孔术患者气管外口再度狭窄需行Ⅱ期气管外口扩大术或戴套管维持呼吸。13.6%的患者可以行喉部分切除术,由于不同的原因行喉全切除术。结论:喉全切除术作为治疗中、晚期喉癌的主要手段,其适应证随喉癌外科技术的发展而逐渐缩小。在采取积极的颈廓清术情况下,局部复发是主要的死亡原因。     

Chondrosarcoma of the tongue: A case report and a review of the literature

Chondrosarcoma of the head and neck is uncommon and reported to constitute between 1% to 12% of all chondrosarcoma cases. 1 , 2 , 3 Extraskeletal chondrosarcoma of the tongue is an extremely rare type of neoplasm with only three previously reported cases. The underlying origin of chondrosarcoma arising in the tongue is controversial. We describe a case of a low‐grade chondrosarcoma arising in the base of the tongue of a 54‐year‐old woman with a central area of dedifferentiation. The patient was treated with complete surgical resection with no evidence of recurrence at 1 year follow‐up.     

Utility of the Montgomery salivary tubes for preventing pharyngocutaneous fistula in total laryngectomy

PurposeTo evaluate the prophylactic, protocolized, and standardized use of a Montgomery tube in preventing pharyngocutaneous fistulas after total laryngectomy and neck dissection.Study designRetrospective cohort study.SettingTertiary referral centre.Subject and methodsA Montgomery salivary bypass tube was placed in 44 patients undergoing total laryngectomy and neck dissection, observing the percentage of fistula appearance and the time of start of deglutition. Comparison was made with a group of 28 patients prior to the implantation of the protocol in whom the tube was not used.ResultsThere was a statistically significant decrease in the percentage of fistulas and an earlier onset of deglutition in the salivary bypass tube patients compared to those in whom the tube had not been used.ConclusionProphylactic and standardized use of the Montgomery salivary bypass tube in patients undergoing total laryngectomy and neck dissection might decrease the incidence of pharyngocutaneous fistula and improve the course of one that is already established.