Endobronchial Metastasis Research Articles

High-dose-rate endobronchial brachytherapy in the management of advanced lung cancer - comparison according to the presence of lung atelectasis

Introduction/Objective. Locally advanced lung cancer is often accompanied by atelectasis of either a part or the entire lung. The aim of this study was to establish the benefits of brachytherapy on the patients? quality of life, the length of the progression-free survival (PFS), and the overall survival (OS) as related to the presence or absence of atelectasis after the applied treatment. Methods. The total of 100 patients with locally advanced lung cancer or endobronchial metastasis of other malignancy were treated with the high-dose-rate endobronchial brachytherapy (HDR-EBB) in 2017. For observing the patients? clinical characteristics, the PFS and OS, the patients were classified into four groups according to the presence of atelectasis before and after HDR-EBB. Results. After HDR-EBB alone or combined with other treatment modalities, a statistically significant symptom alleviation was registered for all the symptoms except cough (p < 0.05). The significantly highest PFS value was registered among the patients with atelectasis prior but not after HDR-EBB. The longest survival was registered in the patients who had atelectasis prior to, but not after HDR-EBB, as well as among the patients without atelectasis either before or after EBB. Conclusion. HDR-EBB is an efficient method that improved the quality of life of most patients. There were improved rates of re-aeration after HDR-EBB treatment alone and as a part of combined treatment. Reaeration after EBB is a positive prognostic factor with respect to PFS and OS of these patients.

Endobronchial Malignant Melanoma: An Exceedingly Rare Occurrence

Malignant melanoma is rarely observed to metastasize to endobronchial tissue. We present a case of endobronchial malignant melanoma in a 36-year-old male smoker with a regressed cutaneous lesion. Due to the limited number of cases and poor survival rate, no definitive treatment options are available to improve survival in patients with this rare disease presentation. Immunotherapy and surgical removal of locally aggressive tumor have been described, but the definitive role for these therapeutic modalities in the setting of endobronchial metastases remains largely unknown.

CUSTOMIZING AIRWAY STENT FOR MULTICENTRIC MALIGNANT AIRWAY OBSTRUCTION

TYPE: Abstract Publication TOPIC: Procedures PURPOSE: A middle-aged man with adenocarcinoma of sigmoid colon and solitary liver metastasis underwent neoadjuvant chemotherapy followed by hemicolectomy and hepatectomy. The cancer progressed and he developed endobronchial metastasis resulting in near-total obstruction of left main bronchus (LMB) and bilateral pulmonary nodules. METHODS: Laser photoresection of LMB tumor was performed followed by covered self-expanding metallic stent (SeMS). He received radiation and anti-angiogenic therapy. Six months later, he complained of worsening dyspnea and stridor. CT Thorax revealed complete occlusion of the distal end of stent with collapse of left lung. Rigid bronchoscopy revealed tumor in-growth through the stent; tumor at the main carina causing 70% obstruction of the right main bronchus (RMB), and a polypoidal mass arising from the right middle lobe bronchus. Tumor debulking was performed within the stent and at the carina with argon plasma coagulation (APC) and rigid forceps, and the polypoidal mass was removed with electrosurgical snare. The left limb of silicone Y stent was cut to accommodate the SeMS while another circular cut was made just beyond the take-off of the right limb. The right limb of Y stent was deployed into bronchus intermedius, the circular cut maintained aeration to the right upper lobe (RUL). Post procedural CXR showed re-expansion of the left lung with satisfactory position of the silicon and SeMS stents. RESULTS: Figure 1. Bronchoscopic images CONCLUSIONS: Complex Airway Obstruction interferes with airflow and insertion of airway stents provide relief and complement ablative techniques. Modification of stents may prove to be beneficial to these patients. CLINICAL IMPLICATIONS: Please refer above DISCLOSURE: No significant relationships. KEYWORDS: central airway obstruction, airway stent

Investigation and Analysis of Primary Lung Cancer with Endotracheal and Endobronchial Metastases

背景与目的气管支气管转移（endotracheal and endobronchial metastases, EEM）在肺癌中罕见，国外文献报道可发生于手术切除后，但国内目前尚未见相关报道，本研究旨在总结和分析肺癌发生EEM的临床特征。方法回顾2015年1月-2018年12月于北京大学第三医院确诊原发性肺癌并行支气管镜的患者，同时检索截至2020年2月PubMed检索系统中的病例，采集并比较两组患者的临床、病理、影像、支气管镜和预后等资料。结果我院共有6例肺癌伴EEM入选，发生率为0.62%（6/967），均为初诊为肺癌时即伴有EEM。鳞癌4例，腺癌1例，小细胞肺癌1例。Ⅲb期1例，Ⅳ期5例。中央型肺癌5例，周围型1例。EEM在支气管镜下表现为肺癌原发灶之外的气道黏膜结节或息肉性病变5例、局灶性黏膜异常1例。转移至对侧支气管5例，至同侧支气管和气管各1例。中位总生存期为7.5个月。从PubMed数据库共检索到13例，其中12例为肺癌术后随诊胸部计算机断层扫描（computed tomography, CT）异常继而确诊为EEM。中央型9例，鳞癌8例，EEM在CT上表现为腔内结节10例，气管壁局限增厚2例，支气管镜下均表现为气道黏膜结节或息肉样病变。转移至气管10例，至对侧支气管5例，至同侧支气管1例。结论EEM是原发性肺癌罕见的转移方式，可发生于初诊时，也可发生于术后，多见于晚期中央型鳞癌，预后差。

A case of diffuse endobronchial metastasis of rectum carcinoma presenting with symptoms of diffuse airway obstruction and respiratory failure

Endobronchial metastases of extra pulmonary tumors are rare. This report presents a case with diffuse endobronchial metastases with rectum carcinoma. A 63-year-old non-smoker female was admitted to our outpatient clinic with dyspnea and dry cough for two months. She had a history of rectum carcinoma and resection surgery eight months ago. On physical examination, wheezing was remarkable. There was patchy consolidation in both lung fields on chest x-ray. PET-CT revealed widespread nodules in pulmonary parenchyma which were consistent with rectal cancer metastasis. Bronchoscopy was performed and revealed extensive mucosal infiltration and multiple various sizes of polypoid lesions in the distal trachea and both main lobar bronchus. The histopathological evaluation reported as metastasis of rectum carcinoma. The oncological medical treatment regimen and radiotherapy was also planned. She admitted to emergency department with chest pain and progressive dyspnea 2 months after the diagnosis. Thorax CT demonstrated that increased metastatic peribronchial infiltrates, septal thickening and endobronchial polypoid lesions which was consisted with lymphangitic carsinomatosis and endobronchial metastasis. There was hypercapnic respiratory failure according to arterial blood gases analysis. She was intubated and admitted to the intensive care unit (ICU) and died in ICU on 7th day of admission. This case indicates that the possibility of endobronchial metastasis should be considered in a patient with underlying malignancy. If available bronchoscopic intervention should be planned not to let misdiagnosis.

A Case of Endobronchial Metastasis from TTF-1-positive Colon Cancer

A Case of Endobronchial Metastasis from TTF-1-positive Colon Cancer

Bronchoscopic management of haemoptysis due to endobronchial metastasis of papillary thyroid carcinoma

Metastatic involvement of lung by thyroid cancer is common, although presentation with endobronchial disease is rarely encountered. When it occurs, threats to airway patency by luminal obstruction and haemoptysis may occur, requiring prompt recognition and intervention to avoid hypoxia and asphyxiation. Bronchoscopic evaluation is essential for both diagnosis and intervention. To our knowledge, we describe the first case of endobronchial papillary thyroid carcinoma elucidated using bronchoscopic biopsy followed by definitive management using argon plasma coagulation (APC) ablation.

Rapid and sustained airway control in metastatic malignant melanoma: a case report.

Endobronchial metastasis from extrapulmonary malignancies are rare and include malignant melanoma. Cases that are complicated by central airway obstruction should follow a patient-centred approach, guided by patient and tumour characteristics. http://bit.ly/32baZvo

Endobronchial metastases secondary to extrapulmonary malignancies

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.

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

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. In this study, we retrospectively examined the data of eleven renal cell carcinoma patients who underwent endobronchial metastases in an eight-year period. 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. 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.

A Rare Case of Endobronchial Metastasis in a Case of Carcinoma Tongue

AbstractCancer of the tongue and other parts of the oral cavity are a leading cause of death in the worldwide population. The common sites of metastasis from oral cavity cancers are lung and bone. Endobronchial metastasis of an extra-thoracic malignancy is a rare phenomenon and such metastases from a malignancy of the tongue are almost unheard of. We present a case of carcinoma oral cavity with subsite tongue that after radical therapy of local site had an unusual site of distant metastasis in the right main bronchus, along with metastases to the lung parenchyma and right third rib.

Endobronchial metastasis from extrathoracic malignancies: A clinicopathological study of 11 cases.

Introduction:Endobronchial metastases are uncommon. It accounts for 2-28%. Most common tumors that metastasis to the endobronchial site are breast, renal, endometrial and colon carcinomas. They have to be identified properly because they present poor prognosis and different treatment modalities when compared to that of primary lung carcinomas.Materials and Methods:We studied a total of 11 retrospective cases of Endobronchial metastasis. Detailed clinic pathological and radiological findings were analyzed along with a detailed Immunohistochemical workup and Endobronchial findings.Results:Mean age of presentation was 55 years with female predominance (Male to female ratio was 1:1.2). Most common tumors encountered were carcinoma breast (3), colorectal carcinomas (2), renal cell carcinoma (2) followed by one each from carcinoma endometrium, cervix and thyroid. Common symptom was cough followed by dyspnea. Exophytic endobronchial growth was common with right main bronchus being the common site.Conclusion:Endobronchial metastasis occurs in various types of malignancies. It should always be differentiated from primary lung carcinomas as they carries poor prognosis and different treatment protocol when compared to that of primary lung tumors.

A Case of Superficial Esophageal Cancer with Suspected Endobronchial Metastasis after Radical Esophagectomy

A Case of Superficial Esophageal Cancer with Suspected Endobronchial Metastasis after Radical Esophagectomy

ENDOBRONCHIAL METASTASIS FROM OSTEOSARCOMA

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Lung is the most frequent site for metastasis from osteosarcoma. Usually, the presentation is with well-defined parenchymal nodules, and unusually with pleural deposits, calcification, or mediastinal nodes. Metastases from osteosarcoma presenting as an isolated endobronchial lesion is discretely rare. CASE PRESENTATION: 36 Y/O man with a diagnosis of osteosarcoma presented with dry cough. The patient CT chest showed a left lower lobe mass with central calcification (figure). The patient underwent bronchoscopy for evaluation left lower lobe mass. The bronchoscopy showed left lower lobe superior segment endobronchial lesion. Hot snare and cryo probe used to debulck the endo bronchial lesion (figure). The lesion was extending deep in the airway and EBUS confirmed the depth of the lesion with the finding for central calcification (figure). Pathology confirmed the diagnosis of metastatic small cell osteosarcoma (figure). DISCUSSION: Airway metastasis of tumors usually rare. The incidence of such metastasis is estimated to be approximately 2%; the most common primary malignancies being renal cell, colorectal, cervical, breast carcinoma, and malignant melanoma.This case presenting an extension of small cell small cell Osteosarcom mass in the left lower lobe into the airway confirmed with EBUS. CONCLUSIONS: Airway inspection is an important test for patient with metastatic tumors to the lung close to a major airways. This will give the chance for a baseline evaluation of the airway for any future progress of disease or future complication of the disease such as hemoptysis. Inexplicable pulmonary manifestations should prompt an early evaluation including bronchoscopy and early institution of local therapy for possible palliation. Reference #1: Mogulkoc N, Goker E, Atasever A, et al. Endobronchial metastasis from osteosarcoma of bone: treatment with intraluminal radiotherapy. Chest. 1999;116:1811–1814 Reference #2: Rubio ER, Chang EE, David O, et al. Pulmonary osteosarcoma: endoscopic management. J Bronchol. 2001;8:277–281 DISCLOSURES: No relevant relationships by Abdul Hamid Alraiyes, source=Web Response No relevant relationships by Mohamed Elrifai, source=Web Response No relevant relationships by Arun Kadamkulam Syriac, source=Web Response

Metachronous endobronchial metastasis from uterine cervical adenocarcinoma

Malignant involvement of the lung can be primary or metastatic. Although primary lung cancer may be endobronchial, parenchymal or both, metastases to the lung are generally parenchymal. However, less commonly, they may be endobronchial. The lungs are the most common site of metastases among all the malignancies. Common extrapulmonary malignancies causing endobronchial metastases (EBMs) are breast, colorectal and kidney. EBMs from uterine cervical cancer are very rare. Although there are a few case reports in the medical literature describing EBM from cervical cancer, none are from adenocarcinoma histology. In this study, we report a case of EBM which on histopathological examination and immunohistochemistry were found to be from a prior adenocarcinoma cervix. Differentiating EBM from bronchogenic carcinoma and other more common extrapulmonary solid organ malignancies may present a clinico-pathological and radiological challenge.

Late Endobronchial Pulmonary Metastasis in a Patient with Breast Cancer.

The lung is a common location for malignant metastases. However, endobronchial metastases from nonpulmonary neoplasms are rare. Metastatic breast cancer usually occurs in 2-3 years of the disease course. A 65-year-old woman visited our hospital for the evaluation of dry cough. The patient had a history of breast cancer, which was treated with modified radical mastectomy and axillary dissection 10 years ago; she was then treated with aromatase inhibitor for 5 years. Chest X-ray revealed right hilum enlargement. Thorax computed tomography revealed a 35-mm diameter mass that was localized in the right hilum. Fiberoptic bronchoscopy was performed, and an endobronchial lesion was observed in the right main lobe carina. Pathological evaluation revealed that the mass was a metastasis of the invasive ductal carcinoma of the breast. Weekly paklitaxel chemotherapy was initiated because of the symptomatic disease. We reported the case of a patient with breast cancer who had an endobronchial metastasis. Her disease-free interval was 10 years. This case indicates that a long-term follow-up of breast cancer is necessary, and biopsies must be performed to make a final diagnosis when any suspicious hilum enlargement is observed.

Carcinoma of prostate with endobronchial and mediastinal lymph node metastasis

Endobronchial malignancies are usually associated with bronchogenic carcinoma. About 1.1% of cases may be due to extrapulmonary source of metastasis. Only few case reports have mentioned about the carcinoma of prostate with mediastinal lymph node and endobronchial metastasis. Here, we report such a case where endobronchial lesions were removed bronchoscopically and the patient improved symptomatically. Biopsy showed the metastatic adenocarcinoma and immunohistochemistry was positive for prostate-specific antigen.

Features of endobronchial metastases from extrathoracic malignancy and positron emission tomography-computerized tomography findings

OBJECTIVE: We aimed to investigate radiological and bronchoscopic aspects of endobronchial metastases (EBMs) from extrapulmonary cancers and the correlation of EBM with findings of integrated positron emission tomography-computed tomography (PET-CT) findings. MATERIALS AND METHODS: Patients who underwent bronchoscopic evaluation between January 2013 and December were analyzed retrospectively. Patients with endobronchial lesions in the airways and histopathologically diagnosed with extrapulmonary cancer metastasis were included in the study. RESULTS: A total of 16 patients with EBM who underwent bronchoscopic biopsies were evaluated. The patients consisted of 10 (62.5%) females and 6 (37.5%) males and the mean age was 61.8 ± 9.1. The common primary cancer related to EBM was breast 9 (%56.4). The mean interval from diagnosis of primary cancer to EBM was 55.1 ± 48.5 (1–180) months. A total of 13 (81.2%) cases were assessed with the PET-CT report. The mean SUVmaxvalue of the lung lesions was calculated as 9.8 ± 4.3. According to PET-CT, 92.4% of the cases had extrapulmonary metastasis. The mean survival duration from diagnosis of EBM was 8.5 ± 6.7 (1–21) months in 9 deceased patients. CONCLUSION: The most frequent extrapulmonary primary tumors with endobronchial metastasis were breast and the mean survival time was usually short. It was reported that most cases were multimetastatic. It was concluded that PET-CT can play a role in identifying the EBM and other organ metastasis and was important tool in planning the treatment.

Endobronchial metastasis of testicular germ cell tumor

Endobronchial metastasis (EBM) of extrapulmonary malignancies is rarely reported; on the other hand, germ cell tumors (GCTs) are extremely rare. This report describes a case of a testicular germ cell tumor presenting as a polypoid endobronchial mass. A 48-year-old male patient had a history of hemoptysis for several weeks. He had undergone orchiectomy due to testicular GCT 20 years ago. Computerized tomography of the thorax obtained endobronchial polypoid lesion in the right intermediate bronchus. Rigid bronchoscopy was applied; right intermediate bronchus was obliterated with a polypoid lesion. The lesion was coagulated with argon plasma coagulation, and debris was removed by biopsy forceps. Pathological examination of the specimen was somatic-type GCT. No recurrence was observed during the follow-up of the patient. We want to present our case to emphasize the importance of distinguishing EBM from primary lung carcinoma which treatment and survival are quite different.

A Case of Endobronchial Metastasis Caused by Colon Adenocarcinoma

A Case of Endobronchial Metastasis Caused by Colon Adenocarcinoma