1- INTRODUCTION
Chondrosarcomas (CS) are cartilaginous tumors that commonly affect bones
like pelvis, ribs or femur 1. They may also affect the
larynx, being the cricoid cartilage the most common site of appearance.
Nevertheless CS can also be originated in thyroid or arytenoid
cartilages, epiglottis or even from hyoid bone 2.
Laryngeal chondrosarcomas (LCS) are extremely rare tumors, representing
less than 1% of all malignancies of the larynx, being the third most
common tumor after squamous cell carcinoma and adenocarcinoma3. LCS behave as locally aggressive tumors, producing
symptoms like dysphonia, dyspnea, dysphagia or hoarseness. In other
cases, they may appear as a neck mass. Computed Tomography (CT) scan and
Magnetic Resonance Imaging (MRI) are the tests of choice in order to
make a presumptive diagnosis 4, although F-18
fluorodeoxyglucose-positron emission tomography (PET) may be used for
grading and local recurrence or metastases detection5. Final diagnosis is based on histopathological
examination. Fine Needle aspiration (FNA) or incisional/excisional
biopsies may support initial diagnosis 6 . As surgical
treatment may be necessary in most cases, histopathological exam of the
tissues will determine the final diagnosis. CS are classified in 3
grades; Grade I, (low-grade, well-differentiated), Grade II
(intermediate-grade, moderately-differentiated) and Grade III
(high-grade, poorly differentiated). There are different subtypes of CS
as clear cell, mesenchymal, extra-skeletal or dedifferentiated (Also
considered as Grade IV) CS 7.
Different approaches for the treatment of LCS have been described in the
literature 8-11. Treatment varies depending upon the
grade of differentiation of the tumor, and the anatomical involvement,
from local resection to total laryngectomy. Radiotherapy (RT) can be
considered in some inoperable patients, for recurrences or in case of
aggressive tumors 5. Disease specific survival of LCS
is higher compared with other laryngeal tumors 3,12.
Papillary thyroid carcinoma (PTC) is the most frequent thyroid tumor,
representing up to 85% of its cancers 13. It is
considered a tumor with good prognosis, with a low risk of recurrence.
Nearly 70% of PTC present lymph node metastasis 14.
This fact is associated with local recurrence and a decrement in
survival rate 15. PTC generally appear as a painless
mass in the thyroid gland, and in rare cases can produce symptoms like
hoarseness or dysphagia. Ultrasound is the imaging test of choice, but
also, CT scan, MRI or PET may be useful to detect extrathyroidal
extension or recurrences 16. FNA, ultrasound-guided or
not, is often the initial diagnostic method used to detect PTC17. Surgical treatment is based on, tumor size,
extra-thyroidal extension or lymph node metastasis. The approach can be
done through lobectomy, near-total or total thyroidectomy, with or
without lymph node removal, depending on the case 18.
Radioiodine is used to ablate remnant normal thyroid tissue19 and hormone therapy is also used in order to
suppress thyrotropin and avoid the growth of remaining papillary cells20.
We report the case of a patient with LCS and cervical LNMPTC. A
systematic review was conducted in order to find similar cases in the
literature.