A 61-year-old woman with a history of pharmacologically controlled arterial hypertension and two episodes of right maxillary sinusitis treated medically four and two years prior to the current problem.
No known allergies and no previous surgical interventions.
In April 1999, the patient presented a subcutaneous right cervical tumor at the angle of the jaw, which was initially related to an acute episode that occurred two months earlier.
Since the appearance of the bulloma, she complains of moderate cervical pain, which is accentuated with rotation movements.
In June of the same year he reported shoulder and upper right limb dysesthesias associated with cervical pain, as well as ipsilateral C2 neuralgia.
Location: a well-defined tumor of gummy characteristics is observed in the right mandibular angle adhered to deep planes and moderately painful to fixation.
There is no long pathway alteration and the cranial nerves are preserved bilaterally.
Research: A complete blood test does not reveal any abnormality.
Cervical MRI is performed, observing a space-occupying lesion occupying the right conjunctive foramen of C2-C3 with expansion of the right posterior interophis joint as well as lateral mass erosion of the right axis.
There is occupation of the anterolateral recess of the spinal canal, but without distortion of the spinal cord.
It previously distorts, displaces and collapses the right vertebral artery and contacts the carotid bifurcation and internal jugular vein without affecting them.
It also distorts the laterocervical muscles, but does not affect them.
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A CAT study is then performed in which a erosion of the lateral mass of C2 is more clearly seen.
Finally, angiography of the supra-aortic trunks demonstrates occlusion of the right vertebral flow.
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Management: in April 2000, a subtotal resection of the tumor by the lateral cervical route was performed with the ENT service in order to obtain a histological diagnosis and reduce the tumor mass.
E1 procedure proceeds without incidents, being discharged five days later.
The patient remains asymptomatic.
Once the diagnosis of well-differentiated grade I chondrosarcoma was obtained, the patient was readmitted one month later to try to complete the resection by the posterior approach, as well as to confer stability to the high cervical spine or the instrumentation.
During the satisfactory course of the procedure, a non-articulated joint erosion of the right C2 and C3 mass and their respective hemilaminae are observed.
An invasion of the right hemibody of the axis is also observed.
The vertebral artery is thrombosed.
The roots of C2 and C3 are located in the right dural sac.
The instrumentation consisted of elective transpedicular stunning of left C2 according to the Goel4 technique, with cranial extension encling three left lateral to caudal extension of the mass, lateral to lateral scala and Coccipital.
Subtotal excision was achieved.
The postoperative course is totally satisfactory, showing the postoperative control radiography a correct fixation.
The patient was discharged nine days later and referred to the radiotherapy service where a 50 Gy course was administered as adjuvant treatment.
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The presence of a right laterocervical adenopathy was confirmed in April 2002.
A new MRI study confirmed tumor recurrence.
Adenopathy was excised and histological analysis confirmed the presence of relapse, resulting in brachytherapy with 40 Gy.
In March 2003, a new tumoral increase was verified; a new surgical intervention was decided, after demonstrating the absence of distant disease.
On this occasion a suprahyoid lateral transcervical approach with subtotal resection is performed.
Elective surgery is also performed.
Both procedures were uneventful.
Unfortunately, three months later a new tumor growth returned with pain radiating to the left upper limb symptomatic treatment confirmed.
A new tumour growth was radiologically confirmed in December 2003 when motor difficulties were present in both upper extremities.
On this occasion, a new surgical intervention was rejected and the administration of chemotherapy was decided following an adriamycin + ifosfamide regimen.
After two cycles, treatment is discontinued due to poor response and high toxicity.
