Endobronchial metastases from colorectal cancer

Pleural and parenchymal lung metastases are frequent in colorectal cancer but endobronchial involvement is rare. An endobronchial metastasis (EBM) is defined as a bronchoscopically visible lesion with the same histology as the primary tumor from which it derives, in patients with extrapulmonary malignancies associated with or without parenchymal or mediastinal lesions. Invasion of the tracheobronchial tree by parenchymal masses or lymph nodes are not considered EBM. Recently a 83-year old man presented with an endobronchial tumoral mass with occlusion of the right middle bronchus, retro-obstructive atelectasis and a right-sided pleural effusion (Fig. 1). On bronchoscopic examination, a complete tumoral obstruction of the right middle bronchial branch was seen. Immunohisto- chemical analysis of the endobronchial biopsies revealed a poorly differentiated cylindric adenocarcinoma, corresponding to the histology of a colorectal carcinoma resected seven years before (at that time staged as pT3N0M0). On CT-scan of the abdomen there were no metastatic lesions.