Ann Thorac Surg 2007;84:1040
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
A Case of Endobronchial and Cutaneous Metastases
Michael K.Y. Hsin, FRCSa,b,
Anthony P.C. Yim, MDa,b,*
a Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Shatin, N. T. Hong Kong
b Department of Surgery, The Chinese University of Hong Kong, Shatin, N. T. Hong Kong
* Address correspondence to Dr Yim, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N. T. Hong Kong (Email: yimap{at}cuhk.edu.hk).
A 54-year-old ex-smoker presented with progressive weakness and shortness of breath. He had finger clubbing as well as widespread umbilicated cutaneous nodules over his neck, chest, abdomen, and back, ranging from 2 to 5 cm in diameter (see Fig 1: photograph shows multiple umbilicated cutaneous lesions over the patient’s chest and abdomen. Also note finger clubbing). Chest roentgenogram showed complete collapse and consolidation of the right lung (see Fig 2: posteroanterior chest roentgenogram shows complete collapse and consolidation of the right lung). A computed tomographic scan of the thorax showed a 7-cm irregular mass encasing the right hilum, and widespread mediastinal lymphadenopathy. An excisional biopsy of a left cervical cutaneous lesion revealed poorly differentiated metastatic adenocarcinoma.
At diagnostic flexible bronchoscopy, an endobronchial tumor was found in the right main bronchus causing subtotal obstruction (see Fig 3: view at bronchoscopy showing occlusion of the right main bronchus by tumor). The bronchial tumor was cored out using a rigid bronchoscope and a Dumon stent (Novatech, Plan de Grasse, France) was placed in the right main bronchial position with significant symptomatic relief.
Histology of the endobronchial tumor confirmed poorly differentiated adenocarcinoma. Immunohistochemical studies are in keeping with metastasis from colorectal origin. The patient was referred to the medical oncologist for chemotherapy.
