Bronchial Metastasis: An Unusual Presentation of Endometrial Cancer

Abstract

INTRODUCTION: Endobronchial metastasis (EM) is usually found at autopsy in 2.3-4.7% of patients with death due to cancer. It is rarely diagnosed clinically, unless the patient presents with symptoms of airway obstruction. Hence, the diagnosis in early stages of the disease is uncommon, leading to a poor prognosis and a systemic treatment of the metastasis. CASE PRESENTATION: We present a 58 year old female with a past medical history of recently diagnosed asthma, hypertension, coronary artery disease, and total abdominal hysterectomy secondary to endometrial cancer five years ago; who presented with right sided abdominal pain with an unremarkable abdominopelvic computed tomography (CT). She also complained of a one-year history of shortness of breath with a dry cough but no hemoptysis; which she attributed to her asthma. The patient denied history of tobacco, alcohol, or illicit drug use. On physical exam, her vital signs were stable and her oxygen saturation was 96% on four liters nasal cannula. Auscultation of the lungs revealed diminished breath sounds over the right lung fields. Thoracic CT demonstrated an almost complete collapse of her right lung secondary to an obstructing right main stem bronchial mass with contiguous hilar and mediastinal adenopathy. A bronchoscopy with biopsy confirmed estrogen and progesterone receptor positive cells with similar morphology when compared to biopsy taken from her endometrial adenocarcinoma, suggesting that her primary endometrial cancer had metastasized to her bronchus. The patient was deemed medically stable and was discharged home with follow-up by oncology, for chemo-radiation treatment of the unresectable mass. DISCUSSION: Endobronchial metastasis is a rare form of metastasis, especially when associated with endometrial cancer as the primary source. In 1996 a study of 32 patients by Salud and colleagues demonstrated only 1 case of EM associated with concurrent endometrial cancer. CT imaging was used in these cases due to its high sensitivity in detecting bronchial lesions. With chemo-radiation, patients with a single EM have a median survival of 8 months. CONCLUSIONS: In this case, EM was incidentally diagnosed years after surgical and radiation treatment of her endometrial cancer. Histological analysis confirmed that her EM was of endometrial origin. Thus, it is imperative that clinicians evaluate for EM in patients with a history of endometrial cancer presenting with any new onset respiratory symptoms.