Correct!
5. All of the above
Biopsy of the obstruction was consistent with metastatic colon cancer (Figure 4).
Figure 4. Histology of the bronchial biopsy consistent with metastatic colon cancer.
Our patient had significant improvement in his dyspnea from debulking of the soft, necrotic tumor in right mainstem bronchus with argon plasma coagulation to control bleeding and extensive suctioning of purulent airway secretions. His chest x-ray also showed significant improvement (Figure 5).
Figure 5. Chest x-ray taken after tumor debulking.
The prevalence of endobronchial metastases is about 2% based on autopsy studies (2). However, the prevalence increases to 18-42% in patients with pulmonary metastases. Endobronchial metastases are most frequently observed in cancers from the breast, kidney, colorectal, uterine cervix, sarcoma and skin cancers (2). In a review of the literature, the mean time from diagnosis of the primary tumor was 50 months (range 0-300 months) and mean survival time from the diagnosis of endobronchial metastasis was 15.2 months (range 0-150 months) (2). Endobronchial metastases from colon cancer reflects these trends. In a series of 42 patients, average survival from primary diagnosis: 70 months (23-245) but median survival after endobronchial metastases were detected was only 14 months (3-40) (3).
The take home messages are that endobronchial metastases tend to arise in the later stages of disease and have increased incidence when pulmonary metastasis are present. Interventional bronchoscopy may offer significant palliative benefit.
References