Endobronchial Metastatic Disease

Persistent collapse of the right lung led to hospitalization of a 62-year-old woman with a history of colon cancer. She had no fever, chills, rigor, or hemoptysis. The patient underwent bronchoscopy to rule out any central endobronchial obstructing lesion. As seen here, an endobronchial tumor at the level of the right main-stem bronchus was occluding the lumen and was thus responsible for the collapsed lung.

Following laser coagulation of the tumor, the bronchus finally reopened, and the lung collapse subsequently resolved. Histopathologic examination of the tumor revealed metastatic adenocarcinoma from the colon cancer. Endobronchial metastases from nonpulmonary tumors are rare, write Drs Arunabh and John C. Rodrigues of Mineola, NY, with an estimated occurrence of about 2%. The usual presentation of such patients includes cough, hemoptysis, and atelectasis.

Endoscopic diagnosis is simple, but histologic examination is necessary to differentiate metastatic adenocarcinoma from primary lung carcinoma. Management of the metastatic lesion depends on the underlying primary malignancy. When there is persistent collapse, cryotherapy or laser coagulation can be used to open the airways. The prognosis remains guarded in these cases.