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.