Large Carinal Chondrosarcoma: Resection of the Main Carina, Distal Trachea, and Orifices of the Mainstem Bronchi and Construction of a New Carina.

Abstract

BACKGROUND Chondrosarcoma of the trachea is an extremely rare malignancy, and tumors located at the main carina are even rarer. Carinal resection and subsequent reconstruction of a new carina constitute a demanding surgical procedure that requires extensive expertise and close collaboration between the anesthetic and surgical teams. In this case report, we aim to highlight the rarity of chondrosarcoma of the main carina and emphasize the critical role of surgical intervention despite the complexity of the procedure. Furthermore, we aim to share our clinical experience and contribute an additional case to the limited literature. CASE REPORT A 23-year-old man presented with dyspnea, fatigue, and cough. Chest computed tomography showed a lobulated soft-tissue mass anterior to the distal trachea and main carina. Fiberoptic bronchoscopy revealed widening of the main carina, clinically significant stenosis of the mainstem bronchi, and mucosal infiltration. Biopsy specimens obtained via mediastinoscopy demonstrated well-differentiated carinal chondrosarcoma. Through a right posterolateral thoracotomy, the distal trachea, main carina, and orifices of the mainstem bronchi were resected. A new carina was constructed and anastomosed to the distal trachea. Gross examination of the surgical specimen showed a well-circumscribed mass with a lobulated external surface measuring 7×6.5×5 cm. The patient remains well 17 years after tumor resection, without signs of recurrence. CONCLUSIONS Chondrosarcoma involving the distal trachea and main carina is an extremely rare tumor. Given the limited efficacy of chemotherapy and radiotherapy, surgical resection with reconstruction of a new carina is the primary treatment.