Endobronchial metastasis from osteosarcoma of bone: treatment with intraluminal radiotherapy

Case of an unusual clinical and radiological presentation of pulmonary metastasis from a costal chondrosarcoma after wide surgical resection: a transbronchial biopsy is recommended

Chondrosarcomas are the most frequently occurring primary malignant chest wall tumors. Furthermore, the lungs serve as the most frequent sites for metastases. Pulmonary metastases from sarcomas usually appear as round nodules of varying sizes on roentgenograms. Here, we report an unusual clinical and radiographic presentation of pulmonary metastasis from a costal chondrosarcoma. Bilateral pulmonary metastases developed soon after wide surgical resection. Thoracic computed tomography revealed unusual radiological findings: consolidation accompanied with ground-glass opacity. To confirm the metastasis, we recommend a transbronchial biopsy in cases where unusual pulmonary findings are detected.

Endobronchial metastasis from primary papillary serous carcinoma of the peritoneum

A 59-year-old woman was admitted to our hospital with a left lower lobe opacity and mediastinal shift on the chest X-ray. She had been complaining of intermittent nonproductive cough and exertional dyspnea. Chest computed tomography (CT) showed an endobronchial tumor of the left main to the lower bronchus, atelectasis of the left lower lobe, and mediastinal shift. Bronchoscopy revealed a polypoid tumor at the distal portion of the left main bronchus that occluded the bronchus. Biopsy specimens from the endobronchial tumor were shown to be serous papillary adenocarcinoma. Since the patient had been treated surgically for primary papillary serous carcinoma of the peritoneum (PSCP) 10 years earlier, immunohistochemical examinations were performed. The diagnosis of endobronchial metastasis of PSCP was confirmed by immunohistochemical staining with cancer antigen 125 (CA125), vimentin, and Wilms tumor-1 (WT-1). This is a rare case of endobronchial metastasis from PSCP.

Orbital metastatic osteosarcoma

A 15-year-old girl with right tibial osteosarcoma, diagnosed 22 months previously, developed right orbital and skull base metastases, with symptoms including painful protrusion of the right eyeball and severe visual impairment. She underwent embolization of the metastatic tumor, local irradiation, and chemotherapy followed by intralesional resection of the mass because extensive involvement of the skull base precluded complete surgical resection. The best corrected visual acuity in her right eye initially decreased to 20/200, then dropped to no light perception after embolization, and then improved to counting fingers at 50 cm after radiotherapy. The symptoms of pain and proptosis subsided completely. After 24 months of follow-up from the presentation of orbital metastasis, the patient's right-eye vision remained unchanged. The surgical specimen revealed a necrotic tumor similar to osteosarcoma. In conclusion, orbital metastasis of osteosarcoma is rare, but may lead to severe visual impairment. Combined radiotherapy, chemotherapy and surgery can partially relieve symptoms, but cannot completely eradicate the tumors.

Photodynamic therapy for endobronchial metastases from nonbronchogenic primaries

BACKGROUND

Endobronchial metastases (EBM) occur in 2% of nonbronchogenic malignancies and frequently present with hemoptysis or dyspnea. This report summarizes our recent experience with photodynamic therapy (PDT) for EBM.

METHODS

All patients who have undergone PDT for the treatment of symptomatic EBM from nonbronchogenic primaries were identified in the Division of Thoracic Surgery database to determine number of treatments, frequency of symptom relief, and patient survival.

RESULTS

Endobronchial PDT was administered to 27 patients from April 1997 through December 2000. The predominant primary tumor was renal cell (44%). Endobronchial metastases presented metachronously in 74% of patients. Patients underwent a median of two PDT treatments. Local anesthesia with sedation was used in 76% of treatments. Four patients (15%) developed immediate postoperative respiratory distress. Follow-up bronchoscopy 24 to 48 hours after initial treatment demonstrated tumor necrosis in all cases. Acute relief of hemoptysis and dyspnea was achieved in 85% of patients. Seven patients died within 6 weeks of treatment. Median survival time after PDT was 4 months (range 0.2 to 30 months).

CONCLUSIONS

Patients with EBM treated with PDT had a median survival of 4 months and patients with limited metastatic disease survived up to 30 months. Photodynamic therapy was effective in palliating hemoptysis or dyspnea from EBM with an acceptable morbidity, although the 30-day mortality was 22%.