Endobronchial metastasis from prostate cancer

Endobronchial metastases 20 years after prostate cancer excision

A 78-year-old Japanese man who had undergone total prostatectomy for prostate cancer (pT3cN1M0, Gleason score 3 + 3) 20 years previously was referred to the Respiratory Medicine Department of our institution because of a 1-week history of chest pain and cough. Computed tomography showed multiple small nodules and mediastinal lymph node enlargement. Bronchoscopy revealed multiple soft polypoid masses and obstruction of the lingular segment. Prostate-specific antigen (PSA) concentrations had increased markedly from 0.48 ng/mL in 2014 to 741 ng/mL in 2018. The diagnosis of prostatic cancer metastases was confirmed by revealing the presence of PSA via immunohistological staining of a bronchoscopically obtained biopsy of one of the masses. The patient had not been attending scheduled follow-up visits for the past 4 years. Treatment with degarelix (a gonadotropin-releasing hormone) was started, and the PSA concentration decreased dramatically (29 ng/mL). Metastases from prostate cancer are rarely first diagnosed two decades after radical prostatectomy. This patient illustrates the importance of obtaining a complete medical history.

Secondary tracheal tumors: a systematic review

BACKGROUND

Secondary tracheal tumors arise from mural invasion by primary tumors in adjacent organs, metastatic lymph nodes or blood-born metastasis from distant sites. This systematic review aims to assess the presentation, management options, and clinical outcomes of these uncommon non-tracheal malignancies.

METHODS

Electronic searches of the MEDLINE database were performed to identify case series and individual case reports of tracheal invasion by primary non-tracheal tumors or metastatic disease. All English-language studies with available abstracts or articles containing primary data were included.

RESULTS

From 1978 to 2017, a total of 160 case reports or case series identified 2,242 patients with invasion of the trachea by tumors of adjacent organs (n=1,853) or by metastatic lymph nodes or hematogenous spread (n=389). Common primary sites of origin were thyroid, esophagus, and lung, and the most common presentation was metachronous (range of interval: 0 to 564 months) with dyspnea, neck mass, voice change and/or hemoptysis. A majority of patients in case reports (77.9%) and case series (66.0%) underwent resection and the most common reported operation was segmental tracheal resection. Fewer patients underwent bronchoscopic intervention (21.7%) and radiation was used in 32.2% of patients. Complications after bronchoscopic treatment included bleeding, granulation tissue, and retained secretions, while anastomotic leak, unplanned tracheostomy, and new recurrent laryngeal nerve paralysis were observed after surgical resection. The rate of 30-day mortality was low (0.01-1.80%). Median survival was higher in patients with thyroid malignancy and in patients who underwent surgical management. Follow-up time ranged from 0.03 to 183 months.

CONCLUSIONS

Patients with tracheal invasion by metastatic or primary non-tracheal malignancies should be assessed for symptoms, tumor grade, tumor recurrence and concurrent metastases to decide on optimal surgical, bronchoscopic or noninterventional therapy. Clinical experience suggests that palliative endoscopic intervention for tracheal obstruction by metastasis-bearing lymph nodes is underreported.

Endobronchial metastasis in a dog with sarcoma

A 3-year-old neutered male Australian Shepherd mix dog presented with metastatic soft tissue sarcoma arising from a primary tumor in the left lumbar fascia. Two separate metastases to the lungs were characterized by neoplasia within bronchiolar walls, which caused obstruction of the bronchiolar lumina and atelectasis of adjacent alveoli, a characteristic feature of endobronchial metastasis. Neoplastic cells of the primary lumbar neoplasm, metastatic pulmonary lesions, and additional widespread metastatic masses identified postmortem were similarly immunoreactive for vimentin, but non-immunoreactive for cytokeratin, cluster of differentiation 18, synaptophysin, chromogranin, and desmin. The present report describes a naturally occurring case of endobronchial metastasis in a dog.

The role of resection of pulmonary metastases from prostate cancer: a case report and literature review

We report a case of a 53-year-old man who presented with two nodules in the lower lobe and one nodule in the upper lobe of the right lung almost 7 years after radical prostatectomy for pT3aN0M0, Gleason 4+5 disease, without evidence of osseous or lymphatic spread. Surgical resection of the lower lung nodules confirmed metastases, but prostate-specific antigen did not drop to undetectable levels. Isolated pulmonary metastases from prostate cancer are rare with only 33 previously described cases in the English-language literature, 18 of which were solitary metastases. We review the principles of management, including metastasectomy and long-term prognosis.

Endobronchial metastasis from prostate cancer mimicking primary lung cancer

Endobronchial metastasis from prostate cancer is a rare neoplasm which metastasizes to the proximal central or subsegmental bronchus, in a bronchoscopically visible range. We present a 72-year-old man with a left superior lobar bronchus mass, intrapulmonary metastases, and bone metastases, mimicking primary lung bronchogenic carcinoma. Increasing tPSA, decreasing fPSA/tPSA level, and prostatic puncture pathology proved prostate cancer. Pathomorphology and immunohistochemistry of the mucosa specimen with P504S, PSA revealed the diagnosis of pulmonary metastases from prostate cancer. The patient was treated by hormonal treatment and chemotherapy. He was in remission thirteen months after diagnosis.