CASE 1320 Published on 24.10.2001

Endobronchial metastasis from renal cell carcinoma

Section

Chest imaging

Case Type

Clinical Cases

Authors

G. Rossi, M. Almberger, V. Votta, L. Bertoletti, E. Iannicelli.

Patient

80 years, male

Categories
No Area of Interest ; Imaging Technique CT, CT
Clinical History
The patient presented with recurrent episodes of haemoptysis, cough and dyspnoea. An endobronchial lesion was demonstrated on CT scanning of the chest.
Imaging Findings
This patient was admitted to the hospital because of recurrent episodes of haemoptysis, cough and dyspnoea. Patient had history of renal cell carcinoma, and right nephrectomy 2 years prior to the examination. On physical examination respiratory sounds in the inferior right lung field were decreased. Routine blood tests were normal. A CT scan of the chest was performed. The examination revealed a 2.5-cm solid endobronchial lesion partially obstructing the main and lower lobe bronchus of the right lung. Multiple areas of atelectasis were present. An enlarged lymph node, 4 cm in diameter, was present in the anterior superior mediastinum. Bronchoscopy confirmed the presence of an endobronchial polypoid lesion protruding into the lumen of the main and lower lobe bronchus of the right lung. Histological examination of the lesion revealed an endobronchial metastasis of renal cell carcinoma.
Discussion
The lung is an extremely common site for metastases from extrathoracic tumours. Endobronchial metastases from non-pulmonary carcinoma is uncommon, occurring in only 2-5% of patients with cancer, according to autopsy findings [1-3]. The tumours showing endobronchial metastasis with greatest frequency are, in decreasing order: breast cancer, renal cell cancer, colon cancer and melanoma. Other authors have found that renal cell carcinoma is the most common lesion involving the bronchus secondarily [4]. Tumour dissemination occurs by haematogenous or lymphatic spread. In fact the bronchi are supplied by the systemic circulation and receive centripetal lymphatic drainage, and thus distal tumour emboli can migrate into the bronchus. The most typical symptoms are coughing and haemoptysis, while dyspnoea is seen less frequently. The radiological manifestations are various and can mimic a central bronchogenic carcinoma. The most typical manifestation is a partial or complete atelectasis [3]. The most frequent sites for metastasis from renal cell carcinoma are: lung, ganglia, liver, adrenal glands, controlateral kidney and brain. Endobronchial metastasis are very rare. After surgical removal of renal cell carcinoma, follow-up imaging is especially important in the first 2 years, when recurrence is most likely [5].
Differential Diagnosis List
Endobronchial metastasis from renal cell carcinoma
Final Diagnosis
Endobronchial metastasis from renal cell carcinoma
Case information
URL: https://eurorad.org/case/1320
DOI: 10.1594/EURORAD/CASE.1320
ISSN: 1563-4086