Endobronchial metastatic disease.

Abstract

Between 1969 and 1979, 90 patients of the Thoracic Surgical Unit at Harefield Hospital were found to have pulmonary metastatic disease. In 25 instances (28 %) the diagnosis was established by bronchial biopsy. Twenty-four patients had endobronchial metastatic carcinoma and in one metastatic sarcoma was diagnosed. All but one had a past history of malignancy, the interval between treatment of the primary and appearance of the endobronchial metastasis ranging from a few months to 17 years. Primary sites in these patients included large intestine, breast, cervix, uterus, and bladder. There were four instances of metastatic malignant melanoma. The pulmonary secondaries were resectable in 10 patients and in one a second resection was done for a further metastasis three years after the first. Three patients are still alive two, four, and 10 years later.It is reported that the incidence of endobronchial metastatic disease is about 2 %.1 This figure was reached by a review of postmortem findings. In the present series of 90 surgical patients with pulmonary metastases, 28 % had endobronchial tumour. All the lesions were readily visible bronchoscopically, involving bronchi proximal to subsegmental level. These findings suggest that the incidence of bronchial involvement by pulmonary secondaries is greater than generally supposed and that bronchoscopy should form an essential part of the investigation and assessment of such patients, whether the diagnosis is suspected or not.

Metástase endotraqueal e endobrônquica de adenocarcinoma de cólon

“…O intervalo entre o diagnóstico do tumor primário e a recidiva pulmonar endobrônquica varia de 3 meses a 25 anos, segundo as séries retrospectivas 1,[4][5][6] .…”

“…Já o comprometimento pulmonar na forma de metástases endobrônquicas é de 2% 1,4,6 . Os tumores sólidos que mais freqüentemente apresentam disseminação endobrônquica são os tumores de cabeça e pescoço, rim, mama e intestino grosso 1 , podendo também ocorrer em carcinoma de tireóide, testículo, bexiga, ovário, colo uterino, útero, pâncreas, esôfago, estomago, melanoma e sarcoma [1][2][3][4][5][6][7] . O intestino grosso é responsável por 11% a 26% dos casos de metástases endobrônquicas 1 .…”

Metachronous endobronchial metastasis from uterine cervical adenocarcinoma

“…8 In contrast, Shepherd found 5 of 25 cases of EBM to be from primary uterine cervical cancer, all of which were of squamous histology. 7 About 15% of uterine cervical cancer patients experience distant metastases, which may be synchronous or metachronous. 9 The average interval of EBM to occur after the diagnosis of primary uterine cervical cancer is 5.4 years.…”

“…Infrequently they may present with nonspecific pulmonary infiltrates and multiple pulmonary nodules. 7,11,12,13 Fibreoptic bronchoscopy is the most important and simplest diagnostic tool and is essential for the diagnosis of endobronchial lesions, with a very high diagnostic accuracy for centrally located lesions. Also, in a known case of another non-pulmonary malignancy, the presence of persistent pulmonary symptoms warrants a FoB even with normal chest radiographic finding.…”

“…Endobronchial metastases (EBMs) from cervical cancer have only occasionally been reported. 5,6,7 Endobronchial metastases may mimic primary bronchogenic carcinoma clinicoradiologically as well as bronchoscopically. Additional immunohistochemical (IHC) staining, together with the specific clinical information, can help in differentiating the two pathologies.…”