Endotracheal Metastases Research Articles

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。

Endotracheal Metastasis from Colon Cancer: A Rare Case

Primary tracheal cancer is a well-known disease while metastases to the trachea from distant sites are exceedingly rare. We report a case of endotracheal metastasis from a colon cancer in a female, who underwent surgery for a sigmoid cancer with no metastases. Five years later, she was diagnosed with a solitary pulmonary metastasis and underwent a left lower lobectomy. After further two years, a tracheal metastasis was found. She was successfully treated with a tracheal resection. In conclusion, it is important to know that colorectal cancer may provide endotracheal metastases. Definitive and aggressive treatment of these metastases is advisable.

Endobronchial/Tracheal Metastasis and Sudden Death

Endobronchial and endotracheal metastases are rare lesions that may cause acute occlusion of major airways. A case is reported of a 62-year-old man with history of renal cell carcinoma and hemoptysis who died after having suddenly become short of breath with cyanosis. At autopsy, recurrent renal cell carcinoma was identified with metastases to the lungs, pulmonary hilar lymph nodes, and brain. In addition, a solitary papillomatous metastasis arising from the mucosa of the carina was obstructing both the main bronchi and distal trachea. Death was due to acute airway obstruction by a metastatic deposit at the bifurcation of the trachea in a case of disseminated renal cell carcinoma. This case demonstrates an extremely rare cause of sudden death that may complicate disseminated malignancy.

Endobronchial metastasis from primary anorectal melanoma

Patient: Male, 64Final Diagnosis: Metastatic anorectal melanoma with endotracheal metastasisSymptoms: Fatigue • weight loss • hematochezia • coughMedication: NoneClinical Procedure: Biopsy of anal mass • rigid bronchoscopySpecialty: Internal medicine • oncology • pulmonologyObjective:Rare diseaseBackground:Anorectal melanoma is a rare cancer with a poor prognosis. The mean survival after diagnosis is 15–25 months. At the time of diagnosis, 61% of patients have local regional lymph node metastases, and 21% have distant metastases. The lungs are a common site for metastasis for all tumors including melanoma. However endobronchial metastasis is a rare phenomenon. Endotracheal metastases are even rarer, occurring in only 5% of patients with extrapulmonary endobronchial metastases. It is most commonly seen in breast, colorectal, and kidney cancers. It is extremely rare for cutaneous melanoma. The mean survival after diagnosis is only 15 months and treatment options are limited.Case Report:We report the case of a 64 year-old gentleman with newly diagnosed metastatic anorectal melanoma. A 3 cm by 3 cm bluish-black, oval-shaped, exophytic mass protruding from his anus was found on physical exam. Endobronchial and endotracheal metastasis to the trachea were discovered on computed tomography and he was subsequently taken to the operating room for argon plasma coagulation laser recanalization of his trachea via rigid bronchoscopy, and resection of his anal mass.Conclusions:We have presented the first known case of anorectal melanoma with endobronchial metastasis. Palliative APC laser recanalization was used to prevent asphyxiation from the endotracheal mass. Endobronchial metastasis is uncommon and can be easily mistaken for primary bronchogenic carcinoma. It should always be considered when evaluating patients with new lung masses.

Tracheal metastasis of small cell lung cancer

Endotracheal metastases of primary lung cancer are rare. Only one case of tracheal metastasis from small cell lung cancer has been reported in literature. Here, we report a rare case of a 45-year-old woman who was admitted for sudden-onset breathlessness with respiratory failure and required ventilatory support. Endotracheal growth was identified during bronchoscopy, and biopsy revealed endotracheal metastasis of small cell lung cancer.

Endotracheal metastases from colon adenocarcinoma

Endotracheal metastases (ETM) from non-lung cancer are seldom seen. Their main clinical symptoms are cough, haemoptysis and dyspnoea, although occasionally an incidental finding is made during a bronchoscopy. Breast, colon and kidney adenocarcinoma might be associated with ETM, lung cancer being the most frequent cause. Its finding is associated with advanced disease but survival will depend on the primary origin, patient status and comorbidity. Therefore, treatment should be individual for each patient. In our centre we recommend pre-surgery bronchoscopy to exclude metastatic endotracheal lesions in patients with metastatic colon adenocarcinoma disease, as this might affect the final outcome and therefore management of the disease.

Endotracheal metastases in renal cell carcinoma: A life-threatening but treatable complication

Endotracheal obstruction, by primary bronchogenic carcinoma or by metastases from extrapulmonary tumors, is a rare and life-threatening complication in cancer patients. The trachea is an extremely rare location for metastases from non-pulmonary tumors. We report a patient with metastatic renal cell carcinoma who developed almost complete obstruction of the trachea and who was successfully managed with bronchoscopic resection of endotracheal metastases.

Metastatic malignancies from distant sites to the tracheobronchial tree

Endotracheal and endobronchial metastases from nonpulmonary malignancies are rare. Since July, 1974, eight patients with such metastases have been seen by the Thoracic Surgical Service at Stanford University Medical Center. Six patients had endobronchial metastases; two from the breast, two from the colon, one from the kidney, and one from the thyroid. Endotracheal metastases from carcinoma of the breast occurred in two patients. Prior treatment of a nonpulmonary neoplasm was known in all patients, and in six of the eight patients metastases to other sites had been previously recognized and treated. The median interval from diagnosis of the primary neoplasm to appearance of the endobronchial or endotracheal metastasis was 5 years. Median survival following diagnosis of such a metastasis was 19 months. Presenting symptoms in patients with endobronchial metastases included cough, hemoptysis, dyspnea, and wheezing. Segmental atelectasis was the major radiographic finding in five of the six patients with endobronchial lesions. Stridor and profound respiratory distress were distinguishing features of the two patients with endotracheal metastases, both of whom required emergency bronchoscopy for palliation as well as diagnosis. Histologic diagnosis of endobronchial and endotracheal metastases is essential in differentiating them from primary tumors of the tracheobronchial tree so that specific treatment may be instituted. The relatively favorable biological behavior of these tumors leads one to be optimistic about the results of treatment, although endotracheal and endobronchial metastases are generally manifestations of far-advanced disease.