A case of endobronchial metastasis of colon cancer mimics sarcoidosis, and a review of related literature.

PURPOSE: Endobronchial metastases (EBM) are defined as bronchoscopically visible lesions histopathologically identical to extrapulmonary tumors. We summarized the literature on endobronchial metastasis of colorectal cancer and give a brief review. METHOD: We present a rare case with an episode mistaken for sarcoidosis and unexpectedly identified as colon cancer by bronchoscopic biopsy. A 53-year-old man with dry cough and dyspnea had diffuse micro lung nodules and lymphadenopathy on CT and PET/CT. He was diagnosed with sarcoidosis and took steroid therapy, but the symptoms could not be alleviated. Bronchoscopy was suggested. He was finally identified with colon cancer by bronchoscopic biopsy, which was confirmed by endoscopic biopsy. We summarise the clinical manifestations, imaging, prognosis of EMB of colorectal cancer. RESULT: EBM are rare. Colorectal cancer is common in EBM and the frequency is increasing. CONCLUSION: EBM should be distinguished from primary lung cancer, sarcoidosis.

Endotracheal, Endobronchial, and Vocal Cords Metastases From Lung Cancer Detected by 18F-FDG PET/CT.

ABSTRACT: A 61-year-old man with a history of lung cancer initially treated 3 years prior presented with a new onset of cough for 1-month and 2-week hoarseness. FDG PET/CT revealed multiple hypermetabolic lesions in the endotracheal, endobronchial, and vocal cords. Subsequently, immunostaining confirmed that all lesions were metastatic squamous cell carcinomas originating from the patient's primary lung squamous cell carcinoma.

Bronchial arterial embolization may reduce the risk of severe bleeding in central airway obstruction due to renal cell carcinomas during bronchoscopic procedures.

BACKGROUND: Hemorrhage is a life-threatening complication during bronchoscopic intervention in patients with central airway obstruction (CAO) due to metastatic renal cell carcinoma (RCC). Whether pre-bronchoscopic bronchial arterial embolization (BAE) can reduce the risk of severe bleeding in CAO patients due to metastatic RCC remains unclear. METHODS: A total of 31 CAO patients due to metastatic RCC were included retrospectively and divided into a BAE group (receiving pre-bronchoscopic BAE) and non-BAE group in this study. Based on computed tomography (CT) and bronchoscopic findings, tumor debulking was used to reconstruct the airway during interventional bronchoscopy. The primary outcome was the incidence of severe bleeding during bronchoscopic procedures. Bleeding-related complications, Karnofsky performance score (KPS) and dyspnea score were also analyzed over a 1-month observation period. RESULTS: There were no significant differences between the two groups in baseline characteristics, including patients' features, tumor morphology under CT scannings, tumor site, and obstruction degree under bronchoscopic examination. Procedure-related bleeding occurred in all 31 patients. Pre-bronchoscopic BAE significantly reduced the incidence of moderate and major bleeding when compared with that in the non-BAE group. The incidence of poor visualization and hypoxia was also reduced significantly in the BAE group. There was no significant difference in KPS and dyspnea score between the BAE and non-BAE groups at 1 month follow up. CONCLUSION: Pre-bronchoscopic BAE might be a feasible option to reduce the risk of severe bleeding for CAO patients due to metastatic RCC during bronchoscopic intervention. Interventional bronchoscopy was a safe and effective procedure for CAO due to metastatic RCC.The reviews of this paper are available via the supplemental material section.

Incidental Finding of Endobronchial Metastasis by 18F-FDG PET/CT Leads to Change in Management in a Patient With Rectal Adenocarcinoma.

A 58-year-old man with history of resected rectal adenocarcinoma and synchronous unifocal pulmonary metastasis showed a solitary pulmonary relapse in follow-up CT after 3 years of complete remission. Resection was planned. Preoperative F-FDG PET/CT detected a high focal F-FDG uptake in the left main bronchus. Bronchoscopy showed a papillary endobronchial lesion that was biopsied. Histology confirmed distant colorectal metastasis. The initial treatment plan changed, and the recommendation for systemic therapy was made by a multidisciplinary oncology team. Endobronchial metastases are rare and difficult to detect in conventional CT. PET/CT is useful to uncover endobronchial metastasis, which may change patient management.

The role of interventional pulmonology in endobronchial metastasis of renal cell carcinoma.

INTRODUCTION: Although metastasis of extrapulmonary solid organ malignant tumors to the lungs is very common, endobronchial metastases are very rare. The most common extrapulmonary tumors that make endobronchial metastases are breast, kidney and colorectal carcinomas. MATERIALS AND METHODS: In this study, we retrospectively examined the data of eleven renal cell carcinoma patients who underwent endobronchial metastases in an eight-year period. RESULT: Ten of the patients were male and the mean age was 55 ± 1 (41-71) years. The most common symptom was cough (45.5%, n= 5), on the other hand 18.2% (n= 2) of the patients had no complaints. Right bronchial system, left bronchial system and tracheal distribution rates of endobronchial lesions were 45.5% (n= 5), 63.6% (n= 7) and 27.3% (n= 3) respectively. The mean time from diagnosis of primary renal cell carcinoma to endobronchial metastases was 47.5 ± 32 (5.2-100.5) months. A total of twenty two interventional procedures were performed. All except one patient underwent endobronchial treatment. Argon plasma coagulation was most commonly used as the endobronchial metastases option (n= 10, 100%). The mechanical resection (n= 6, 60%), laser (n= 5, 50%), cryoextraction (n= 5, 50%) and cryotherapy (n= 4, 40%) methods were used other than argon plasma coagulation. The mean survival time was 19.4 ± 15.7 (3.2-40.5) months after endobronchial metastases and 54.0 ± 40.4 (8.7-107.6) months after renal cell carcinoma diagnosis. CONCLUSIONS: Extrathoracic malignancy that most metastasis to the airways is renal cell carcinoma. Endobronchial treatment procedures for endobronchial metastasis of renal cell carcinoma can be performed with low complication rates.

[Endobronchial metastases secondary to extrapulmonary malignancies]. / Ekstrapulmoner malignitelere bagli endobronsiyal metastazlar.

Although parenchymal, pleural and mediastinal lymph node locations of metastatic Lung cancer are frequently seen, they are rarely found endobronchially. Endobronchial metastases comprise a portion of central airway obstructions that are diagnosed and treated by interventional pulmonology. Interventional procedures for endobronchial metastases (EBM) can help us reach early diagnosis, or in advanced cases with respiratory symptoms, used palliatively.

Endobronchial metastasis as an uncommon pattern of metastatic dissemination from small cell osteosarcoma.

Endobronchial metastasis (EBM) from extrapulmonary primary malignancy is a rare entity. Although the most common site of metastasis of osteosarcoma is the lungs, EBM remains a rare occurrence. Cough and dyspnea are the most common symptoms. A significant number of patients are asymptomatic, making the diagnosis without any radiographic imaging challenging. CT scan of the lung, along with bronchoscopy and biopsy, is the mainstay of diagnosis and staging. A 36-year-old man presented with small cell osteosarcoma of the left maxillary region and was treated with surgery and adjuvant chemotherapy. The patient presented 8 years later with axillary metastasis and was found to have lung metastasis on further workup. Bronchoscopy and biopsy proved an EBM that was debulked by hot snare technique. The patient was then started on chemotherapy for recurrent small cell osteosarcoma.

Primary salivary gland-type tumors of the tracheobronchial tree diagnosed by transbronchial fine needle aspiration: Clinical and cytomorphologic features with histopathologic correlation.

BACKGROUND: Primary salivary gland-type tumors of the tracheobronchial tree are rare; their cytologic features have been seldom reported. We aim to describe the clinical and cytomorphologic features of tracheobronchial salivary gland-type tumors diagnosed by transbronchial fine needle aspiration (TBNA) at our institution, and correlate the findings with a corresponding surgical specimen. METHODS: We searched our laboratory information system to identify patients with a primary salivary gland-type neoplasm of the tracheobronchial tree diagnosed by TBNA and with a corresponding surgical pathology specimen, over 10 years. RESULTS: The study cohort consisted of 11 patients (7F/4M; mean age 58 years, range 41-78). Presenting symptoms included hemoptysis (4), cough (3), dyspnea (1), stridor (1), and shoulder pain (1). Most had a tracheal mass (5), while 3 had mainstem bronchi masses and 3 had lung masses. Radiographically, the masses were lobulated, rounded, or polypoid in six patients. All underwent TBNA with a 21- or 22-gauge needle and endobronchial biopsy. The most frequent diagnosis was adenoid cystic carcinoma (4/11, 36%), followed by mucoepidermoid carcinoma (3/11, 27%), epithelial-myoepithelial carcinoma (2/11, 18%), oncocytoma (1/11, 9%), and hyalinizing clear cell carcinoma, salivary gland type (1/11, 9%). The surgical pathology specimens confirmed the diagnosis in all cases. CONCLUSIONS: To our knowledge, this is one of the largest cytomorphologic studies of primary salivary gland tumors of the tracheobronchial tree in the literature. Salivary gland tumors of the tracheobronchial tree are rare, and recognizing cytomorphologic changes that occur in salivary gland-type tumors is important for establishing a definitive diagnosis.

Case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae tracheobronchial mycetoma.

Cunninghamella is a member of the class Zygomycetes. Cunninghamella species include ubiquitous filamentous fungi; infections caused by Cunninghamella species are less frequent but have higher mortality rates than infections caused by Mucorales group members such as Rhizopus and Mucor. Herein, we reported a rare fatal case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae tracheobronchial mycetoma. A 73-year-old female with a history of right-sided breast cancer who had undergone mastectomy 11 years previously and had no recurrence presented to our emergency department with a 1-week history of left-sided back pain. Chest X-ray revealed left lung atelectasis; bronchoscopy revealed an endobronchial mass lesion in the left main bronchus. Pathological examination revealed fungal mycetoma but malignant lesions were not detected. Endobronchial and lung mycetoma caused by Cunninghamella bertholletiae were initially diagnosed; liposomal amphotericin B was administered, but her condition deteriorated. Rigid endoscopy showed growth of hemorrhagic tissue occupying the left main bronchus just under the carina. Pathological examination of the shaved lesion revealed metastasis from breast cancer covered with abundant necrotic tissue. No mold was observed in the necrotic tissue; this was probably due to liposomal amphotericin B treatment. To our knowledge, this is the first case of endobronchial metastasis from breast cancer accompanied with Cunninghamella bertholletiae mycetoma. Distinguishing endobronchial metastases from breast cancer and atypical presentations of Cunninghamella endobronchial mycetomas can be very difficult. Repeated bronchoscopies maybe helpful in establishing an accurate diagnosis when clinical prognosis does not match the initial diagnosis.

Endobronchial, laryngeal and mediastinal melanoma: a rare constellation of metastatic disease.

A 45-year-old man presents with acute respiratory failure. Imaging revealed a left mainstem endobronchial mass with subcarinal lymphadenopathy, but no other evidence of a primary tumour. An incidental laryngeal nodule was found during bronchoscopy. Biopsies of this lesion by nasopharyngoscopy and subcarinal lymph nodes via mediastinoscopy were performed. Histopathological and immunohistochemical examination showed evidence of melanoma in both samples. Mutational analysis identified the presence of a BRAFV600E mutation. The patient underwent bronchoscopic ablation of the left mainstem endobronchial tumour with laser therapy followed by initiation of encorafenib and binimetinib combination therapy. The patient remains alive at 4 months after initial presentation of disease. This case adds to the body of literature highlighting the clinical heterogeneity and challenges of the management of metastatic pulmonary melanoma. To the best of our knowledge, this simultaneous constellation of metastasis has not been described before.

Unusual endobronchial prostatic metastatic tumor occluding right main bronchus.

Endobronchial metastasis from extrapulmonary solid tumors is rare, and endobronchial metastasis from the prostate is even more unusual. An 80-year-old patient presented with significant dyspnea secondary to metastatic stromal cell sarcoma of the prostate, which occluded the right main bronchus. The tumor, causing complete collapse of the right lung, was found on computed tomography and confirmed by bronchoscopy. We successfully excised the lesion using cryotherapy, with immediate resolution of symptoms and radiological lung reexpansion.

Endobronchial metastasis from renal cell carcinoma as a reason for recurrent pulmonary infections.

Endobronchial metastases (EBM) secondary to extrathoracic malignancies are very rare. Breast cancer, colorectal cancer and renal cell carcinoma represent the most common types of cancer leading to endobronchial metastases. They usually represent a late manifestation of other types of cancer and their prognosis is generally poor averaging a survival of 1-2 years in most case series. Due to their rarity, they remain a challenge for clinicians regarding whether they are primary lung tumors or not. This case report article intends to present a case of a young man with a left nephrectomy due to Clear-Cell Renal Cell Carcinoma, who developed EBM 7 years later and to summarize available data in the field. Furthermore, the utility of diathermic snare as a treatment approach for this entity is highlighted.

Problems to affect long-term survival for breast cancer patients: An observational study of subsequent lung/bronchus malignancies.

The overall survival of breast cancer (BC) patients increased significantly for decades; however, their long-term survival was seriously impaired by subsequent malignancies. This study aimed to investigate the risk factors of subsequent lung / bronchus primary malignancies among BC survivors.A total of 535,941 BC female survivors diagnosed were identified by using SEERStat database in 1973 to 2014. Among them, 9398 had subsequent lung/bronchus malignancies. Clinico-pathological risk factors were evaluated for the development of subsequent lung/bronchus cancer. The main measures were the incidence and risk factors of subsequent lung/bronchus primaries. Logistic regression analysis and survival analysis were performed.Overall, among 535,941 BC survivors, 73,394 (13.69%) patients with subsequent primaries were identified from 1973 to 2014. The overall medium second tumor-free time was 72 months. Estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, human epidermal growth factor receptor-2 (HER2)-positive, radiotherapy, and surgery treatment were protective factors against overall subsequent malignancies, whereas HER2/hormone receptor (HR) subtype triple negative, increasing tumor size, low differentiation grade, and high TNM stage were risk factors associated with overall subsequent malignancies. Surgical implantation reconstruction was risk factor for lung/bronchus cancer. Even though BC patients had a favorite 5-year survival, their long-term survival was affected by subsequent malignancies, especially for lung/bronchus cancer with high mortality.Nearly 13% BC survivors suffered from subsequent malignancies. Increased risk was related to HER2/HR triple negative and advanced TNM stages. Radiotherapy and surgery were protective factors. Our findings may inform the subsequent cancer counseling of female BC survivors.

[Reference bases of radiotherapy under stereotaxic conditions for bronchopulmonary, hepatic, prostatic, upper aero-digestive, cerebral and bone tumors or metastases]. / Bases référentielles de la radiothérapie en conditions stéréotaxiques pour les tumeurs ou métastases bronchopulmonaires, hépatiques, prostatiques, des voies aérodigestives supérieures, cérébrales et osseuses.

Since decades, stereotactic radiotherapy has spread out worldwide. Published results are very numerous. To clarify obviousness among all the publications, this recommendation review was written. Voluntarily, authors limited analysis of international best evidence literature on malignant tumors of lung, liver, prostate, head and neck, and metastasis of bone and brain. These data could be used to advance standardization and quality improvement of treatments performed in the nationwide radiotherapy departments and can provide useful guidance for centers worldwide.