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Accepted Article
Endobronchial metastases of colorectal cancer
Natalia-Zuberoa Rosado Dawid, Francisco Ramón Villegas
Fernández, María del Mar Rodríguez Cruz, Asunción Ramos
Meca
DOI: 10.17235/reed.2016.4080/2015
Link: PDF
Please cite this article as: Rosado Dawid Natalia-Zuberoa,
Villegas Fernández Francisco Ramón, Rodríguez Cruz María
del Mar, Ramos Meca Asunción . Endobronchial metastases
of colorectal cancer. Rev Esp Enferm Dig 2016. doi:
10.17235/reed.2016.4080/2015.
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CD 4080 inglés
Endobronchial metastases of colorectal cancer
Natalia-Zuberoa Rosado-Dawid1, Francisco Ramón Villegas-Fernández2, María del Mar
Rodríguez-Cruz1 and Asunción Ramos-Meca1
Services of 1Gastroenterology and 2Neumology. Hospital Central de la Defensa Gómez
Ulla. Madrid, Spain
Correspondence: Natalia-Zuberoa Rosado Dawid
e-mail: [email protected]
Key words: Endotracheal metastases. Endobronchial metastases. Colorectal cancer.
Dear Editor,
The most common locations for colorectal metastases are liver, lung and peritoneum
(1). Metastases arising in colon, small bowel, adrenal glands or ovaries are a rare
event.
Lung metastases from colorectal cancer arise in the pulmonary parenchyma; however
metastases on the tracheobronchial wall are anecdotal (2).
Case report
We present a 76-year-old asthmatic woman with two lung metastases from a well
differentiated rectal adenocarcinoma (pT2N0M1, stage IVa), located in the middle lobe
and the left inferior lobe. The patient received neoadyuvant radio-chemotherapy,
rectal surgery and chemotherapy. Because of a good response to treatment she
underwent pulmonary resection of metastases one year later. No other comorbidities
were reported.
In her annual medical exam, one year after lung surgery, the patient presented with
intermittent inspiratory stridor and dyspnea. She needed 2 litres/min flow of oxygen to
maintain 95% arterial oxygen saturation.
Conventional chest X-ray revealed multiple bilateral different sized pulmonary nodules
and a loss of right lung volume. Computed tomography showed a 15 mm solid lesion
located 5 mm below the vocal cords. A similar lesion was blocking the right main
bronchus. There were many small nodules in both lungs. No abdominal disease was
reported.
A rigid bronchoscopy was performed showing an obstruction of 90% of the
tracheobronchial lumen (Fig. 1) and multiple 2-3 mm sessile metastases. The biggest
lesions were treated using Nd:YAG laser and argon plasma coagulation, relieving the
airway obstruction without any complications. Histological analysis demonstrated
rectal adenocarcinoma tissue. Endobronchial brachytherapy after local ablative
therapy was not necessary although new ablative sessions were considered if required
to maintain our patient’s quality of life.
Discussion
Endobronchial metastases due to solid organ primary tumors are uncommon and
generally caused by head and neck cancer. Twenty six percent of these lesions are due
to colorectal cancer (2). One single case of anal origin has been reported (3).
Tracheobronchial metastases often occur later in the course of the disease after
parenchymal dissemination so they have a poor prognosis (4,5) and benefit from
palliative and symptomatic management. The main symptoms are dyspnea, cough and
hemoptysis, although 50% produce no symptoms. Radiological findings have poor
sensibility and detect up to 55% of tracheobronchial metastases. It is appropriate to
perform a bronchoscopy to better characterize these lesions. Treatments employed
should be individualized and are determined by the histology of primary tumor,
location, symptoms and patient’s performance status (5), including chemotherapy,
brachytherapy, local resection as well as other techniques. In our case no retreatment
was required after 15 months but the patient finally died because of her cancer
disease.
We should consider the presence of tracheobronchial metastases in patients with
colorectal cancer and parenchymal pulmonary spread. Survival and quality of life
depend on these lesions. Although their prognosis is poor, these patients may benefit
from endoscopic palliative management in experienced hands.
References
1. Edge SB, Compton CC. AJCC Cancer Staging. 7th Edition; 2010.
2. Marchioni A, Lasagni A, Busca A, et al. Endobronchial metastasis: An epidemiologic
and clinicopathologic study of 174 consecutive cases. Lung Cancer 2014;84:222-8.
DOI: 10.1016/j.lungcan.2014.03.005
3. Dalmases M, Lucena CM, Cano Jiménez E, et al. Metástasis endobronquiales de
carcinoma
de
canal
anal.
Arch
Bronconeumol
2012;48:25-60.
DOI:
10.1016/j.arbres.2011.07.007
4. Fournel C, Nertoletti L, Bguyen B, et al. Endobronchial metastases from colorrectal
cancers: Natural history and role of interventional bronchoscopy. Respiration
2009;77:63-9. DOI: 10.1159/000158487
5. Kiryu Y, Hoshi H, Matsui E, et al. Endotracheal/endobronchial metastases:
Clinicopathologic study with special reference to developmental modes. Chest
2001;119:768-75. DOI: 10.1378/chest.119.3.768
Fig. 1. Tracheal lesion seen through the vocal cords.