Endobronchial Metastasis of a Primary Transitional-Cell and Signet-Ring Cell Carcinoma of the Urinary Bladder

Abstract

Endobronchial metastasis is generally a late finding of primary tumor or may be determined before the diagnosis of primary tumor. We present a rare case of primary transitional and signet-ring cell carcinoma of the urinary bladder that occurred with malignant pleural effusion and endobronchial metastasis. A 71-year-old man complained of dyspnea and hematuria. He was admitted to the intensive care unit (ICU) with a prediagnosis of acute respiratory failure. He had decreased respiratory sounds and fine rales bilaterally at the lung bases. Respiratory failure worsened, and he was placed on mechanical ventilation. Radiograph and computed tomogram revealed bilateral effusion and metastatic nodules in the lung parenchyma. Subsequent abdominal computed tomogram revealed a mass in the urinary bladder, and transurethral biopsy indicated transitional epithelial carcinoma (modified Bergvist grade IIIB, and World Health Organization/International Society of Urological Pathology higher-grade urothelial papillary carcinoma) and signet-ring cell carcinoma, with lymphovascular invasion, consistent with the pathology findings. Our treatment plan was radical cysto-prostatectomy, followed by chemotherapy and radiotherapy, but because of his very poor medical status, the operation was not performed. On the 5th ICU day he died from severe respiratory failure, despite intensive supportive therapy. This case highlights the need to rule out malignancies in other organs in patients admitted with severe respiratory symptoms.

Endobronchial/Tracheal Metastasis and Sudden Death

“…Endobronchial and endotracheal metastases are uncommon event that have been associated with a wide range of thoracic and extrathoracic malignancies. The incidence is between 2–5% of autopsies on patients with extrapulmonary malignancies . The most common tumors giving rise to airway metastasis are carcinomas of the breast, colon, and kidney (as in the current case) .…”

“…The most common tumors giving rise to airway metastasis are carcinomas of the breast, colon, and kidney (as in the current case) . However, a wide variety of less common primary sites include the nasopharynx, parotid gland, maxilla, thyroid gland, gonads, pancreas, adrenal gland, prostate, bone, bladder, and uterus, in addition to occurring in cases of melanoma, plasmocytoma, and liposarcoma . Distinguishing endobronchial metastasis from a primary bronchogenic carcinoma is important in patients, as the approach and treatment are different, and the prognosis is generally poorer .…”

Pulmonary manifestations of urothelial carcinoma of the bladder

“…While uncommon, patients may also present with endobronchial metastasis (EBM) [9,10]. The presenting symptoms include cough, wheezing, dyspnea, stridor or hemoptysis.…”

Multinodule abnormalities of the tracheobronchus: bronchoscopy findings and clinical diagnosis

“…Multiple nodules, however, are associated with various conditions. For example, amyloidosis , tracheobronchopathia osteochondroplastica (TO) , relapsing polychondritis, trachea‐bronchomegaly, endobronchial metastases (EBM) , sarcoidosis , neurofibromatosis, rheumatoid arthritis , tuberculosis (TB) and other granulomatous lesions, such as granulomatosis with polyangitis and lymphomas .…”