title: Endobronchial metastasis: an epidemiologic and clinicopathologic study of 174 consecutive cases.
abstract: OBJECTIVE
  Endobronchial metastases from extrapulmonary solid tumors are a rare event and currently available epidemiological and clinico-pathological data mainly derive from anecdotal case reports.
  
  
  METHODS
  A series of 174 consecutive cases of endobronchial metastases from extrathoracic solid tumors were collected over a period of 18 years. Immunohistochemistry was performed in 115 cases. Complete imaging features were available in 81 patients, and analysis of the latency period between primitive tumor diagnosis and occurrence of endobronchial metastasis was obtained.
  
  
  RESULTS
  Among all bronchoscopic examinations performed in the same period for malignancy, a mean of 5.6 cases per year consisted of endobronchial metastases (range 2-17 cases), with a statistically significant increase when comparing the periods 1992-2000 (65 cases, 37%) and 2001-2009 (109 cases, 63%) (p = 0.05). Overall, 4% of endobronchial biopsies for suspected malignancy disclosed an endobronchial metastasis from extrapulmonary tumor. Breast (52 cases, 30%), colorectal (42 cases, 24%), renal (14%), gastric (6%) and prostate (4.5%) cancers and melanoma (4.5%) were the most common metastatic neoplasms presenting as endobronchial mass. One-hundred fifty-four cases were identified after the primitive tumor diagnosis (metachronous cases, 89%), 11 cases were simultaneously evidenced in extrapulmonary and endobronchial sites (synchronous cases, 6%), while 9 occult metastatic cases (5%) first presented as endobronchial mass (anachronous cases). Overall, mean latency from extrapulmonary tumor diagnosis and endobronchial metastasis was 136 months (range, 1-300 months). The most frequent symptoms were dyspnea (23%), cough (15%) and haemoptysis (12%), while 26% of patients were totally asymptomatic. At radiology, 53% presented as multiple pulmonary nodules, while other cases presented as hilar and mediastinal mass, single peripheral nodule, atelectasis or pleural effusion.
  
  
  CONCLUSIONS
  Endobronchial metastases from extrapulmonary tumors account for about 4% of all bronchoscopic biopsies performed for suspected malignancy and in 5% of the cases the metastasis is the first manifestation of the neoplasm.
authors.affiliation: Department of Oncology and Hematology, Respiratory Diseases Clinic, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy. Electronic address: marchioni.alessandro@unimore.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marchioni
authors.affiliation: Department of Oncology and Hematology, Respiratory Diseases Clinic, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Lasagni
authors.affiliation: Operative Unit of Pulmonology, Hospital "Cattinara", Trieste, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Busca
authors.affiliation: Operative Unit of Pathologic Anatomy, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cavazza
authors.affiliation: Operative Unit of Pulmonology, Azienda Ospedaliera Arcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Agostini
authors.affiliation: Department of Diagnostic Laboratories, Operative Unit of Pathologic Anatomy, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Migaldi
authors.affiliation: Department of Oncology and Hematology, Respiratory Diseases Clinic, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Corradini
authors.affiliation: Department of Diagnostic Laboratories, Operative Unit of Pathologic Anatomy, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
mesh_terms: D000368:Aged; D001984:Bronchial Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology*
keywords: Bronchoscopy; Bronchus; Endobronchial; Immunohistochemistry; Lung; Metastasis