Multiple tracheal metastases of lung cancer: CT and integrated PET/CT findings

[Investigation and Analysis of Primary Lung Cancer with Endotracheal and Endobronchial Metastases]

背景与目的

气管支气管转移（endotracheal and endobronchial metastases, EEM）在肺癌中罕见，国外文献报道可发生于手术切除后，但国内目前尚未见相关报道，本研究旨在总结和分析肺癌发生EEM的临床特征。

方法

回顾2015年1月-2018年12月于北京大学第三医院确诊原发性肺癌并行支气管镜的患者，同时检索截至2020年2月PubMed检索系统中的病例，采集并比较两组患者的临床、病理、影像、支气管镜和预后等资料。

结果

我院共有6例肺癌伴EEM入选，发生率为0.62%（6/967），均为初诊为肺癌时即伴有EEM。鳞癌4例，腺癌1例，小细胞肺癌1例。Ⅲb期1例，Ⅳ期5例。中央型肺癌5例，周围型1例。EEM在支气管镜下表现为肺癌原发灶之外的气道黏膜结节或息肉性病变5例、局灶性黏膜异常1例。转移至对侧支气管5例，至同侧支气管和气管各1例。中位总生存期为7.5个月。从PubMed数据库共检索到13例，其中12例为肺癌术后随诊胸部计算机断层扫描（computed tomography, CT）异常继而确诊为EEM。中央型9例，鳞癌8例，EEM在CT上表现为腔内结节10例，气管壁局限增厚2例，支气管镜下均表现为气道黏膜结节或息肉样病变。转移至气管10例，至对侧支气管5例，至同侧支气管1例。

结论

EEM是原发性肺癌罕见的转移方式，可发生于初诊时，也可发生于术后，多见于晚期中央型鳞癌，预后差。

CT Findings of Central Airway Lesions Causing Airway Stenosis-Visualization and Quantification: A Pictorial Essay

The tracheobronchial tree is a system of airways that allows the passage of air to aerate the lungs and entire body. Several pathological conditions can affect this anatomical region. Multidetector CT (MDCT) helps identify and characterize various large airway diseases. Post-processing tools, such as virtual bronchoscopy and automatic lung analysis, can help enhance the performance of imaging studies. In this pictorial essay review, we provide imaging findings of various bronchial lesions manifested as wall thickening and endoluminal nodules on conventional MDCT and advanced image visualization and analysis.

Multiple Endotracheal Metastases of Lung Cancer after Bronchoscopic Intervention

A 65-year-old man presented with obstructive pneumonia due to squamous cell carcinoma of the lung, which invaded the right main bronchus. Argon plasma coagulation was performed, which reduced his symptoms. Right pneumonectomy was performed after preoperative chemotherapy; the pathological diagnosis was T3N1M0 Stage IIIA. Fifteen months after surgery, he presented with bloody sputum. Bronchoscopy showed multiple endotracheal tumors, and a pathological examination revealed squamous cell carcinoma; the same histology as the primary lung cancer. We hypothesized that direct implantation during bronchoscopic therapy or hematogenous or lymphatic spread might have led to metastasis. A careful follow-up is required after bronchoscopic therapy.