Abstract Introduction Metastatic involvement of the central airways from colorectal adenocarcinoma is exceedingly rare. Although pulmonary metastases occur in approximately 10 to 20 percent of colorectal cancer cases, only 2 to 5 percent of these have endobronchial involvement. Tracheal metastases are seldom seen, though present major challenges and significant clinical implications due to the risk of life-threatening airway obstruction and respiratory failure. We present a case of metastatic sigmoid adenocarcinoma involving the distal trachea and bilateral mainstem bronchi, successfully managed with bronchoscopic tumor ablation and metallic Y-stent placement. Case Presentation A 60-year-old woman with history of stage IV sigmoid adenocarcinoma, initially diagnosed ten years prior and treated with sigmoidectomy followed by adjuvant FOLFOX chemotherapy, presented with progressive dyspnea. She was receiving systemic therapy with FOLFIRI and bevacizumab for known hepatic and mediastinal metastases. Chest CT demonstrated a mass involving the distal trachea and bilateral mainstem bronchi, resulting in critical luminal narrowing. A rigid bronchoscopy was performed and revealed a large obstructive mass occluding approximately 80 percent of the trachea and approximately 50 percent of mainstem bronchi (Fig. 1 A,B). She underwent tumor ablation with cryotherapy and placement of a metallic Y-stent with near complete recanalization of the central airways (Fig. 1 C,D). Histopathologic analysis of the tracheal biopsy showed adenocarcinoma positive for CK20, CDX2 and negative for TTF-1 and CK7, consistent with metastatic colorectal origin. She was later referred for palliative radiation therapy to the trachea and mediastinal lymph nodes. Discussion Central airway metastases from colorectal cancer are rare and often underrecognized. Mechanisms include hematogenous seeding and extensions from mediastinal disease. Clinical manifestations such as dyspnea, cough, wheeze, or stridor can closely mimic obstructive lung diseases and respiratory infections. This case highlights a rare presentation of metastatic disease from colorectal cancer and the important role of bronchoscopic interventions in the management of central airway obstruction. Rigid bronchoscopy with mechanical debulking and cryotherapy or laser ablation allow for immediate relief of occlusion via removal of endoluminal tumor tissue. Airway stenting serves to establish and maintain airway patency. Optimal management of tracheobronchial metastases requires a multidisciplinary approach involving interventional pulmonology, medical oncology, and radiation oncology to improve local disease control and reduce the likelihood of recurrence. This abstract is funded by: None
Nguyen et al. (Fri,) studied this question.