Abstract Introduction Malignant central airway obstruction (MCAO) is caused by significant stenosis of the tracheal or bronchial airways due to primary or metastatic thoracic cancers. Interventions such as bronchoscopy, tumor debulking, and airway stenting have been shown to significantly reduce morbidity and mortality. This case describes a patient with a refractory MCAO secondary to metastatic cribriform adenocarcinoma of the tongue and minor salivary glands (CATSMG). Case Description Our patient was an 81-year-old female with stage I CATSMG treated with radical neck dissection eight years prior who presented with dyspnea and hemoptysis. Imaging demonstrated a right-sided mediastinal mass encasing the trachea and right mainstem bronchus. Supraclavicular lymph node biopsies confirmed metastatic CATSMG, and the patient was discharged with oncology follow-up. She re-presented eighteen days later with worsening dyspnea, and imaging demonstrated interval enlargement of the mass. The following day, she developed severe respiratory distress requiring emergent intubation. Bronchoscopy demonstrated extrinsic compression and endobronchial invasion into the trachea extending to the right main bronchus with 80% occlusion and overlying blood clots that were therapeutically aspirated. She was transferred to an outside hospital for tumor debulking and Y-shaped tracheal stent placement, after which she was extubated. On readmission, she acutely decompensated with respiratory distress while working with physical therapy, requiring re-intubation. Bronchoscopy showed a patent stent with tumor extension underneath causing partial obstruction and significant blood clots that were aspirated. The patient had difficulty weaning from the ventilator and decided to transition to comfort care, and she passed away three days later. Discussion This case demonstrates a successful tumor debulking and stenting for an intrinsic and extrinsic airway obstruction secondary to a metastatic salivary adenocarcinoma. CATSMG is extremely rare and has never been reported as cause of MCAO. MCAO is considered a poor prognostic indicator due to increased risks of respiratory failure, but median survival has been shown to improve by three to six months with interventions like debulking, stenting, and bronchoscopy. Of these patients who undergo airway stenting, greater than 90% symptomatically improve and greater than 50% liberate from mechanical ventilation. Our patient was successfully extubated after stent placement but ultimately decompensated due to her friable tumor and airway mucosa. Despite low complication rates with airway stenting, patients like ours are still at risk for obstructive secretions and hemoptysis. This report illustrates an interesting case of MCAO due to a metastatic salivary carcinoma and demonstrates the role of procedural interventions in patient management. This abstract is funded by: None
Sundaram et al. (Fri,) studied this question.