Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment
Naohiro Taira, Tsutomu Kawabata, Tomonori Furugen, Takaharu Ichi, Kazuaki Kushi, Tomofumi Yohena, Hidenori Kawasaki, Kiyoshi Ishikawa
Department of General Thoracic Surgery, National Hospital Organization, Okinawa National Hospital, Okinawa, Ginowan, Japan
Am J Case Rep 2015; 16:483-485
Available online: 2015-07-23
Endobronchial metastases derived from nonpulmonary tumors are uncommon, although a variety of malignant tumors have been reported to be associated with endobronchial metastasis. We herein report a case of repeated bronchoscopic resection of endobronchial metastasis of a thymic carcinoma.
CASE REPORT: A 59-year-old woman was diagnosed with primary thymic carcinoma, Masaoka stage IVA, in May 2009. In June 2013, she developed dyspnea. A chest CT scan revealed left upper lobe atelectasis, and a polypoid lesion was noted in the left upper bronchus on bronchoscopy. A pathological examination of the lesion revealed metastatic thymic carcinoma, and bronchoscopic resection was performed for symptom relief. However, the lesion was partially resected, based on the operative findings, which showed the peripheral part of B3 to be the origin of the polypoid lesion and bronchoscopy could not be used to reach this site. Although the patient underwent repeated partial bronchoscopic resection of the polypoid lesion due to the symptoms of dyspnea caused by regrowth of the polypoid metastatic thymic cancer in the left upper bronchus, she remains alive with an excellent performance status and no evidence of widespread or other metastases for more than 5 years after the initial diagnosis.
CONCLUSIONS: We speculate that this case was successfully managed with repeated partial bronchoscopic resection because thymic cancer tends to be a slow-growing tumor. Therefore, it is worth resecting endobronchial metastatic thymic carcinoma repeatedly in such cases, even if the resection is partial.
Keywords: Bronchial Neoplasms - therapy, Bronchoscopy, Carcinoma, Squamous Cell - therapy, Thymus Neoplasms - pathology