title: Management of tracheal chondrosarcoma almost completely obstructing the airway: a case report.
abstract: BACKGROUND
  Primary malignant tracheal tumors account for only 0.2 % of all malignancies of the respiratory tract. Tracheal chondrosarcoma is a rare condition and only 17 cases have been described in the literature from 1965 to date. Herein we report the very unusual case of a patient with a tracheal chondrosarcoma, electively treated by curative surgery despite the virtually complete obstruction of the airway.
  
  
  METHODS
  We present the case of a 79-year old Caucasian man with long-lasting wheezing misdiagnosed as asthma and affected by a tracheal chondrosarcoma almost completely obstructing the airway. Videobronchoscopy and imaging investigations revealed a well-circumscribed mass arising from the cartilaginous rings of the cervical trachea with a posterior residual respiratory space of about 1 mm. Because of the mobility and flaccidity of the uninvolved pars membranacea, the tiny respiratory space slightly expanded during inspiration and expiration allowing the patient to be treated without an essential emergency procedure. Standard tracheal intubation was impossible. Rigid bronchoscopy enabled placement of a small tracheal tube distally to the tumor. Successful cervical tracheal resection and reconstruction was then performed, achieving complete tumor excision. Histologically, the mass was characterized as a low-grade tracheal chondrosarcoma. Videobronchoscopy performed 9 months after surgery showed a wide, well healed tracheal anastomosis. Ten months after surgery, the patient is alive and disease free.
  
  
  CONCLUSIONS
  Complete surgical resection is the treatment of choice for tracheal chondrosarcoma. Rigid bronchoscopy is an essential tool for diagnostic and therapeutic purposes. It allows the palliative maneuvers for obstruction relief but also, in resectable patients, the intraoperative safe and straightforward management of the obstructed airway.
authors.affiliation: Department of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy. marcoandolfi@hotmail.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Andolfi
authors.affiliation: Department of Thoracic Surgery, G. Mazzini Hospital, University of L'Aquila, Teramo, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vaccarili
authors.affiliation: Department of Thoracic Surgery, G. Mazzini Hospital, University of L'Aquila, Teramo, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Crisci
authors.affiliation: Department of Thoracic Surgery, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D002813:Chondrosarcoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003951:Diagnostic Errors; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D012135:Respiratory Sounds / Q000209:etiology; D014132:Trachea / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
keywords: Rigid bronchoscopy; Trachea; Tracheal chondrosarcoma; Tracheal resection; Tracheal stenosis