Chondrosarcoma of the Cervical Trachea in an Octogenerian,
A Case Report
Aivars Berzins *1, Pavel-Sorin Fisteag 1, Uldis Kopeika 1, Dirk Bausch 1, Sebastian Daehnke 1,
Barbara Kirch 2, Miriam Fels 2, Thomas Krbek 1
Correspondence to: Aivars Berzins, Bethanien Hospital Moers, Germany.
Copyright
© 2026 Aivars Berzins. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 19 October 2026
Published: 01 November 2026
DOI: https://doi.org/10.5281/zenodo.23910238
Introduction
Chondrosarcoma of the head and neck region is a exeptionaly rare disease [10, 6], and primary malignant tracheal tumors account for only 0.2% of all malignancies of the respiratory tract [5]. The vast majority of the malignant tracheal lesions are squamous cell carcinoma and adenoid cystic carcinoma [11]. Common symptoms of a tracheal chondrosarcoma include dyspnoe, wheezing and cough, followed by hemoptysis, hoarsness and odynophagia [9]. The preferd treatment option is surgical resection with end-to-end anasto-mosis [2, 7, 1, 12, 4]. Endobronchial laser treatment has also been reported in the literature [3]. We present the case of an octogenarian with a tracheal chondrosarcoma and describe our multidisciplinary therapeutic approach, combining the expertise of thoracic surgery, interventional bronchology, anes-thesiology, and pathology.
Case
An 88-year-old caucasian female with a history of arterial hypertension pre-sented to the emergency department via emergency medical services following a referral from her primary care physician. She reported a progressive, non-productive cough and resting dyspnea persisting for four months. Recent outpatient treatment with amoxicillin/clavulanic acid and oral corticosteroids had not resulted in clinical improvement.
Prior to this episode, the patient was highly functional, independent in her activities of daily living, and had not required inpatient hospitalization for four decades. On presentation, physical examination was largely unremark-able except for inspiratory stridor and spastic breath sounds on pulmonary auscultation.
Laboratory evaluation revealed leukocytosis, most likely secondary to re-cent outpatient pulse corticosteroid therapy. Initial emergency management included blood cultures, intravenous prednisone, and nebulized bronchodila-tor therapy with salbutamol and ipratropium bromide to address possible treatment-resistant airway hyperresponsiveness.
A CT-Scan showed an obstructing mass in cervical trachea, see Figure 1. Bronchoscopy with needle biopsy was subsequently performed, as shown in Figure 2.
Initial histological results from the pincer biopsy showed no evidence of malignancy. After discussion of the case in our interdisciplinary team meeting, we decided to proceed with cervical exploration and partial tracheal resection with end-to-end anastomosis.
The patient was placed in a supine position with both arms retracted. General anesthesia was administered, and the patient was intubated under bronchoscopic guidance using a 7.0 mm endotracheal neuromonitoring tube. High-frequency jet ventilation was kept on standby for the tracheal resection and anastomosis. Two experienced anesthesiologists were present in the operating room throughout the entire procedure. A central venous catheter was placed in the left femoral vein.
Trachea was anastomosed using Prolene 3-0 uninterrupted suture, as shown in Figure 6. At the end of the suture jet-ventilation was stopped to avoid barotrauma. The endotracheal tube was repositioned, and the anastomosis was tested for air leakage. Frozen-section analysis confirmed tumor-free resection margins. Both recurrent laryngeal nerves were stimulated and showed preserved signals. A pretracheal drain was inserted, and the wound was closed in layers.
On the evening after the operation, the patient developed subcutaneus emphysema. Therefore, bronchoscopic control was performed on the following day to rule out anastomotic insufficiency. No insufficiency was detected, and the remaining postoperative course was uneventful. The subcutaneous emphysema had completely resolved by the sixth postoperative day. The patient was discharged the day after. At follow-up, the patient showed a positive clinical outcome with no signs of tracheal obstruction.
Discussion
Primary malignant tumors of the trachea are exceedingly rare, and tracheal chondrosarcoma represents an exceptional entity. Because symptoms such as cough, wheezing, dyspnea, or stridor are non-specific, diagnosis is often delayed and may initially be misinterpreted as asthma, chronic obstructive pulmonary disease, or treatment-resistant airway hyperresponsiveness. In our patient, symptoms persisted for four months despite outpatient antibiotic and corticosteroid treatment before computed tomography revealed an obstructing cervical tracheal mass.
This case illustrates the diagnostic limitations of bronchoscopic biopsy in cartilaginous tracheal tumors. Initial needle biopsy showed no evidence of ma-lignancy. However, the obstructing nature of the lesion, its rigid consistency, its origin from the tracheal wall, and the patient’s progressive symptoms made a purely endoscopic or observational approach insufficient. After inter-disciplinary discussion with thoracic surgeons, interventional bronchologists, anesthesiologists, and pathologists, surgical resection was chosen as the most definitive diagnostic and therapeutic strategy.
The initial differential diagnosis included benign cartilaginous tumors such as hamartoma or chondroma. Distinguishing benign from low-grade malignant cartilaginous lesions can be difficult in small biopsy samples; therefore, complete resection may be required both to relieve airway obstruction and to establish the final diagnosis.
From a surgical perspective, feasibility depends mainly on tumor location, resection length, and the possibility of achieving a tension-free anastomosis. In our patient, the calculated resection length was approximately 2.6 cm, corresponding to about 20% of the total tracheal length. Xia et al. showed that sleeve resections up to six rings is feasable and safe [13]. Endoscopically, the tumor involved three tracheal rings beginning at the second tracheal ring. Careful cervical and mediastinal mobilization allowed primary end-to-end anastomosis without prophylactic tracheostomy, as noted in literature [8].
Although the patient was an octogenarian, she had been functionally inde-pendent and had no relevant pulmonary comorbidity. Thus, chronological age alone was not considered a contraindication to surgery. Instead, the decision was based on functional status, tumor-related airway compromise, and interdisciplinary risk assessment.
A key aspect of the procedure was close cooperation between endocopy team, surgery and anesthesia. Airway management during cervical tracheal resection is challenging, especially when the tumor itself compromises the airway. In this case, bronchoscopically guided intubation and standby high-frequency jet ventilation enabled safe intraoperative airway control.
The postoperative course was favorable. Although subcutaneous emphy-sema developed on the evening after surgery, bronchoscopic control excluded anastomotic insufficiency. The emphysema resolved completely by the sixth postoperative day, and the patient was discharged on the seventh postopera-tive day. At follow-up, she showed no signs of recurrent tracheal obstruction. Half a year after the procedure, the patient is active again and can even ride her bicycle daily.
Conclusion
This case demonstrates that tracheal resection with end-to-end anastomosis can be a feasible and safe surgical option for selected octogenarian patients when careful interdisciplinary planning and perioperative preparation are ensured.