The patient was a 72-year-old man with a superior mediastinal.

The patient was a 72-year-old man with a superior mediastinal, paratracheal mass that was first noted upon a chest x-ray film obtained 3 years earlier during a hospitalization after a tractor accident. Further evaluation was not undertaken at that time given the seriousness of the patient's trauma. The patient survived his injuries and across the following 3 years noted progressive breathlessness with exertion. The patient had none smoked and denied weight los dysphagia, or chest pain. Medical history was otherwise noncontributory.

Physical examination revealed an somewhat advanced in life man in no apparent distress at repose Vital signs were stable on the contrary chest examination revealed scattered rhonchi. Stridor could be provok with voluntary hyperventilation. An x-ray film examination of the chest, shown in Figure 1 illustrates a left paratracheal mass causing significant tracheal compression. Pulmonary function touchstones confirmed a severe obstructive ventilatory imperfection with impaired expiratory flows suggesting a variable intrathoracic obstruction of the trachea. A chest comput tomography (CT) scan confirmed a well-defined mediastinal mass measuring about 5X4X5 cm The mass caused significant lateral compression of the left side of the trachea, and a portion appeared to be intraluminal. Multiple punctuate calcifications within the mass were noted (Fig. 2) Bronchoscopy confirmed high grade, extrinsic, midtracheal compression with minimal mucosal abnormality. A thoracotomy was performed.

Diagnosis: Chondrosarcoma of the trachea

This somewhat old gentleman presented with several years of progressive dyspnea. A high-grade tracheal obstruction was the source of his dyspnea. The patient underwent a right thoracotomy with the finding of a 7- to 8-cm hard, circular mass impinging on the left side of the trachea. The mass was raise to arise from the distal trachea. After its resection, bitter tracheomalacia at the adjacent squeeze [i]or[/i] press together [i]or[/i] into smaller compassed tracheal cartilage necessitated resection of a 3-cm longitudinal dimensions of trachea and a primary end-to-end anastomosis. Gros pathology showed a 65 cm incompletely encapsulated, white-tan mass that was partially calcified. Histologic features supported a diagnosis of chondrosarcoma.

Primary neoplasms of the trachea are same rare[1] and have a slight malignant predominance in adults and a slight benign predominance in children.[2] Of the malignant neoplasms of the trachea, squamous confined apartment carcinoma comprises 80 to 90 percent These neoplasms, however, alone account for 0.2 percent of all respiratory tract malignancies.[2,3] Chondrosarcoma of the trachea is uniform rarer with only seven known cases in the literature (including the general case). Of these, six were in men and common was a woman. The age range for this clump was 48 to 74 years.

There appears to be an calm distribution within the trachea of the chondroid malignancies.[4-6] The most numerous common symptoms are chronic nonproductive cough dyspnea forward exertion, and stridor.[1,4-6] Les general symptoms include hemoptysis, atelectasis, and postobstructive pneumonia from extension into the mainstem bronchi. If there is a large extraluminal element the first clinical symptoms may be superior vena cava obstruction or Horner's syndrome

Plain film evaluation of chondrosarcoma of the trachea present to views a well-circumscribed mass indenting the air line as in our patient. A CT has added significantly to the evaluation of similar neoplasms and is currently the preferr radiographic modality for evaluation. It allows evaluation of size and volume of the lesion as well as involvement of contiguous structures[4] The CT typically indicates a large, lobulated mass with coarse calcifications arising from the tracheal wall and significantly narrowing the tracheal lumen[2] Chondroid neoplasms nurse to be predominantly intraluminal with extraluminal extension more commonly seen in the chondrosarcomas (as in our patient). Chondrosarcomas are also more apt to cause tracheal wall thickening than their benign counterparts.[5,6] The CT appearance is not pathognomonic for a chondroma or chondrosarcoma, and the differential diagnosis includes hamartomas and chondroblastomas.

Pathologically, chondrosarcomas of the trachea are usually well-differentiated tumors with benign clinical characteristics. Pathology present to views a fairly well-circumscribed gray-white firm mass arising from a cartilage ring. The preferr treatment is tracheal resection with end-to-end primary anastamosis. The incidence of local return appears low.[1,6]

REFERENCES

[1] Matsuo T Kinoshita s Iwasaki K, Shibata M, Ushio T Kawata s et al. Chondrosarcoma of the trachea: a case report and literature review. Acta Cytol 1988; 32:908-12

[2] Slasky B Hardesty RL Wilson s Tracheal chondrosarcoma with an overview of other tumors of the trachea. J Comput Tomogr 1985; 9:225-21

[3] Young JL Percy CL Asire AJ, ed Surveillance, epidemiology and close results: incidence and mortality data, 1973-1977 US Department of Health and Human Services. Bethesda, Md: National Cancer Institute, 1981; 58

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