SMALL CELL LUNG CANCER PRESENTING AS ENDOTRACHEAL MASS

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Tracheal tumors are most often adenoid cystic or squamous cell carcinoma in origin. Far less commonly, they may be due to high grade neuroendocrine carcinomas, which are divided into large and small cell carcinoma subtypes. Although both are often metastatic at time of diagnosis, high grade neuroendocrine carcinomas are rarely found endotracheal or endobronchial on initial presentation. Therefore, the natural history and approach to management for such lesions has yet to be clearly defined. CASE PRESENTATION: 60 year old male with history of hypertension, 40 pack year tobacco smoking history and frequent alcohol abuse presented with dyspnea, cough, wheezing and weakness for the past two months. Exam notable for stridorous respiratory sounds. Computed tomography of his chest revealed an 1.6 cm x 1.8 cm intraluminal tracheal mass, 2.0 x 1.0 cm right lower paratracheal lymph node, and 1.6 x 1.1 subcarinal lymph node. Bronchoscopy disclosed a tracheal mass just proximal to the carina. This lesion was biopsied. Cytologic examination returned as high-grade neuroendocrine carcinoma with submucosal invasion. Multidisciplinary discussion at tumor board concluded pathology to be small cell lung cancer (SCLC). After completing staging workup, patient determined to be limited stage SCLC as positron emission tomography with computed tomography was only notable for the intratracheal lesion. Patient started on radiation and chemotherapy with cisplatin and etoposide. One week later, patient presented to the hospital again for worsening shortness of breath. Repeat bronchoscopy revealed roughly 90% luminal narrowing. He underwent tumor debulking with argon plasma coagulation and cryotherapy with subsequent balloon dilation of the trachea, right mainstem bronchus, and bronchus intermedius. His symptoms of dyspnea and wheezing markedly improved. Cytologic examination of the tracheal mass again returned with diagnosis of high-grade neuroendocrine carcinoma. Patient is currently undergoing chemoradiation. DISCUSSION: We report the case of small cell lung cancer presenting as an endotracheal mass with mediastinal lymphadenopathy. After determining the patient to be limited stage SCLC, we took an interventional approach with tumor debulking as opposed to a surgical one. CONCLUSIONS: Due to the infrequency with which SCLC presents as a tracheal mass, the optimal approach to treatment has yet to be determined. However, this case suggests in distal trachea, an endoscopic approach followed by adjuvant chemoradiation may be appropriate. Reference #1: Chua, W, et al. A Case of Primary Small Cell Carcinoma of the Trachea. J Bronchol 2008;15:49-51. Reference #2: Heikal, M. Small-Cell Cancer Presenting as a Tracheal Polyp A Case Report and Review of the Literature. J Bronchol Intervent Pulmonol 2012;19:132-136. DISCLOSURES: No relevant relationships by Sarung Kashyap, source=Web Response No relevant relationships by Essam Mekhaiel, source=Web Response