Abstract Introduction Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumor with a high propensity for recurrence and distant metastases. While common metastatic sites include the liver, brain, and bone, direct metastasis to the trachea is exceptionally rare. We present a case of life-threatening tracheal obstruction due to recurrent SCLC, initially mimicking a primary tracheal malignancy, in a patient with a complex oncologic history including prior laryngeal squamous cell carcinoma. Case Presentation A 61-year-old male with limited-stage SCLC of the left upper lobe—treated years earlier with pneumonectomy and six cycles of carboplatin/etoposide—was subsequently diagnosed with subglottic squamous cell carcinoma, managed with resection and adjuvant radiation. He remained in remission until presenting with progressive dyspnea.CT chest revealed two tracheal masses (1.9 cm and 1.5 cm) causing ∼75% luminal obstruction. Bronchoscopy was aborted due to inability to traverse the lesion. Biopsy confirmed small cell carcinoma. The patient underwent urgent rigid bronchoscopy with mechanical and thermal tumor debulking, restoring airway patency from 95% obstruction to complete opening. A right vocal cord lesion was visualized but not biopsied, with otolaryngology follow-up arranged.Post-procedure, the airway remained patent. PET/CT showed no extratracheal disease, and brain MRI was negative for intracranial metastasis. He was started on carboplatin, etoposide, and atezolizumab, tolerating three cycles well.Two weeks after discharge, follow-up bronchoscopy demonstrated residual tumor at the ablation site along the left anterolateral and posterior tracheal walls, with persistent right vocal cord lesion. Systemic therapy was continued. He completed eight cycles of carboplatin, etoposide, and atezolizumab, then transitioned to atezolizumab maintenance. Follow-up nasopharyngoscopy showed mobile vocal cords with resolution of the previously noted lesion, and repeat CT neck demonstrated no enhancing mass or cervical lymphadenopathy. He remains asymptomatic and under follow-up with hematology-oncology, pulmonology, and otolaryngology. Discussion Tracheal metastases from SCLC are exceedingly rare, with few reported cases. Distinguishing them from primary tracheal tumors is challenging, particularly in patients with multiple prior malignancies. This case highlights two critical lessons: (1) the necessity of rapid recognition and intervention in obstructive tracheal masses, and (2) the diagnostic complexity of overlapping primary and secondary aerodigestive tract malignancies. Pathology confirmed recurrence of SCLC rather than a new primary. Aggressive multidisciplinary management, including bronchoscopic debulking and systemic therapy, can restore airway patency and lead to durable resolution of obstructive lesions in patients with life-threatening airway compromise due to malignancy This abstract is funded by: None
Alali et al. (Fri,) studied this question.