Small cell lung cancer with endobronchial growth: A case report

Successful bronchial arterial infusion chemotherapy combined with radiotherapy for an endobronchial metastasis after resection of small cell lung cancer

Bronchial arterial infusion (BAI) chemotherapy has been reported to be an effective treatment option for centrally located early-stage squamous cell lung cancer (SCC) and has a favourable response rates for patients with stage III or IV or recurrent non-small cell lung cancer (NSCLC) without distant metastases who cannot tolerate standard chemotherapy. Here, we report a case of an 83-year-old male with a solitary polypoid endobronchial metastatic tumour in the left main bronchus one year and 10 months after video-assisted thoracoscopic surgery (VATS) combined segmentectomy (left S6 + S8a) for small cell lung cancer (SCLC), pT1bN0. He was treated with BAI of 100 mg of cis-Diamminedichloroplatinum/cisplatin (CDDP), followed by thoracic radiotherapy (56 Gy in 28 fractions). There was no recurrence for 2.5 years. BAI chemotherapy combined with radiotherapy seemed to be an effective salvage option for the treatment of solitary endobronchial metastases of SCLC in patients unfit for standard chemoradiotherapy.

Endobronchial Small-cell Lung Cancer with Intraluminal Growth Pattern Showing "Finger-in-glove" Appearance

Invasion of the endobronchial mucosa by cancer cells is frequently seen in small cell lung cancer (SCLC), but an intraluminal polypoid growth pattern is extremely rare. We herein describe the case of a 69-year-old woman with limited-stage SCLC who had a pedunculated mass in the orifice of the right upper bronchus. Thin-section CT of the lung showed an endobronchial protruding mass accompanied by tubular and branching opacities (the so-called finger-in-glove sign) in the right upper lobe bronchus, which were enhanced by contrast media. She responded well to chemotherapy with concurrent radiation therapy. Although very rare, SCLC patients can have intraluminal polypoid growth, as was observed in this case.

Outcome of incidentally detected airway nodules

Low-dose chest computed tomography (LDCT) screening increased detection of airway nodules. Most nodules appear to be secretions, but pathological lesions may show similar findings. The National Comprehensive Cancer Network (NCCN) recommends repeating LDCT after 1 month and proceeding to bronchoscopy if the nodules persist. However, no reports exist about incidentally detected airway nodules. We investigated the significance of airway nodules detected by LDCT screening.We screened patients with incidental airway nodules detected by LDCT in the Seoul National University Hospital group. The characteristics of computed tomography, bronchoscopy, pathology and clinical findings were analysed.Among 53 036 individuals who underwent LDCT screening, 313 (0.6%) had airway nodules. Of these, 186 (59.4%) were followed-up with chest computed tomography and/or bronchoscopy. Seven (3.8%) cases had significant lesions, including leiomyoma (n=2), endobronchial tuberculosis (n=2), chronic inflammation (n=1), hamartoma (n=1) and benign granuloma (n=1). The remaining 179 lesions were transient, suggesting that they were secretions.The use of LDCT for lung cancer screening demonstrated the low incidence of airway lesions. Most lesions were transient secretions. True pathological lesions were rare, and no malignant lesion was found. The current recommendation of the NCCN guideline is a reasonable approach that can avoid unnecessary bronchoscopy.