Endotracheal/Endobronchial Metastases

Endotracheal/endobronchial metastases(EEMs) from nonpulmonary neoplasms are rare. However, their definitionand developmental modes have not yet been fully elucidated. EEMs were defined as documented nonpulmonaryneoplasms metastatic to the subsegmental or more proximal centralbronchus, in a bronchoscopically visible range. The clinical and pathologic features of 16 cases were reviewed, with special emphasis onthe developmental modes based on five criteria: location in thetracheobronchial tree, number of lesions, laterality of lesions, depthof lesions, and relationship with the associated bronchus. The developmental modes were proposed on the basisof the above five criteria as follows: type I, direct metastasis to thebronchus; type II, bronchial invasion by a parenchymal lesion; typeIII, bronchial invasion by mediastinal or hilar lymph node metastasis;and type IV, peripheral lesions extended along the proximal bronchus. Primary tumors included colorectal in six patients, breast in threepatients, uterus in two patients, osteosarcoma of the bone in twopatients, and maxillary, larynx, and parotid carcinoma in one patienteach, respectively. The mean recurrence interval was 65.3 months. Thedevelopmental modes were as follows: type I, five patients; type II, one patient; type III, four patients; and type IV, nine patients. Threepatients underwent surgical resection. One patient has remained wellfor 5 years after operation. Median and mean survival times were 9months and 15.5 months, respectively. Themean recurrence interval was long at 65.3 months, but the mean survivaltime was short at 15.5 months. Type I accounted for only 5 of 16patients. Type II was found in only one patient. It is thought thatthis type is a rare form. Type IV affected nine patients. Treatmentplans must be individualized, because in some cases, long-term survivalcan be expected.