Abstract Hemoptysis is a common clinical symptom with a broad differential, including infection, inflammatory airway disease, and malignancy. Rarely, it may signal pulmonary metastases from extrathoracic tumors, with breast cancer representing the most frequent source of endobronchial metastasis (EBM). Although biopsy-proven breast cancer accounts for 20-30% of EBM cases, isolated endobronchial involvement as the first or sole manifestation of recurrence is exceedingly uncommon-reported in fewer than 5% of cases-and may occur years or even decades after initial treatment. We describe a rare case of recurrent male breast cancer presenting solely as EBM manifesting with hemoptysis, nearly 20 years after the initial diagnosis. A 73-year-old man with a history of coronary artery disease, hypertension, and right-sided ductal carcinoma in situ (DCIS) treated in the early 2000s with mastectomy, adjuvant radiation, and five years of Tamoxifen, presented in 2024 with recurrent, low-volume hemoptysis. He had a right chest wall recurrence of invasive ductal carcinoma (ER+, PR+, HER2-) in 2021, managed with surgical excision and endocrine therapy. Initial evaluation for hemoptysis at an outside hospital attributed his symptoms to pneumonia, but hemoptysis persisted despite antibiotics. Serial contrast-enhanced CT and CTA imaging revealed a right upper lobe nodule with surrounding ground-glass opacity, initially interpreted as pneumonia or scarring. Bronchoalveolar lavage (BAL) demonstrated rare atypical cells amidst mixed inflammatory elements. A repeat CTA localized bleeding to the posterior segment of the right upper lobe, but no active extravasation was seen. Subsequent peripheral bronchoscopy revealed a discrete endobronchial lesion in the same segment. Biopsy confirmed metastatic mammary carcinoma with neuroendocrine features, ER and PR positivity, and equivocal HER2 expression, consistent with metastatic breast origin. This case illustrates an exceptionally rare presentation of isolated EBM as the sole manifestation of recurrent male breast cancer, nearly two decades after initial treatment, and three years after local recurrence to the chest wall. Pulmonary metastases from breast cancer usually involve the parenchyma or pleura, while direct endobronchial spread occurs in less than 1% of recurrences. The mean latency period is reported to be 136 months, highlighting the potential for late relapse in long-term survivors. Persistent or unexplained hemoptysis in patients with a remote history of breast cancer warrants evaluation for metastatic disease, even decades post-remission. Early bronchoscopy with biopsy is critical, as radiographic findings may mimic infection or inflammation. Recognition of such atypical presentations can facilitate timely diagnosis and management of late metastatic disease. This abstract is funded by: None
Azoulai et al. (Fri,) studied this question.