Baskaran Vadsala, Pugh Laura, Berg Robert James, Anderson John
Department of Respiratory Medicine, Royal Derby Hospital, Derby, UK.
BMJ Case Rep. 2017 Dec 28;2017:bcr-2017-222219. doi: 10.1136/bcr-2017-222219.
Endobronchial metastasis occurs in only 2%-5% of non-pulmonary cancers. Here we report on an 84-year-old woman who presented with breathlessness and light-headedness while on holiday in Australia, 2 years post-treatment for endometrial cancer. Initial CT pulmonary angiogram identified a soft tissue mass in the left hemithorax. A chest radiograph performed after repatriation was consistent with a large left pleural effusion, but bedside ultrasound showed a lobulated mass involving the left hemidiaphragm. A pleural procedure in the traditional 'triangle of safety' would have resulted in inadvertent puncture of the underlying mass. Serial imaging confirmed the mass was rapidly progressing, and metastatic malignant mixed Mullerian endometrial carcinoma was diagnosed by endobronchial biopsy. A tunnelled intrapleural catheter was inserted for symptom relief, and the patient deteriorated and died at home 2 weeks later. To our knowledge, this is the first case of endobronchial metastasis from malignant mixed Mullerian tumour of the uterus.
支气管内转移仅发生于2% - 5%的非肺癌患者。本文报告一例84岁女性，在澳大利亚度假时出现气促和头晕症状，此时距其子宫内膜癌治疗已过去2年。最初的胸部CT血管造影显示左半胸有一软组织肿块。回国后进行的胸部X线检查结果与大量左侧胸腔积液相符，但床边超声显示有一个分叶状肿块累及左半膈。在传统的“安全三角区”进行胸膜穿刺操作会导致无意中穿刺到下方的肿块。系列影像学检查证实肿块进展迅速，经支气管活检诊断为转移性恶性混合性苗勒管子宫内膜癌。为缓解症状插入了一根经隧道的胸腔内导管，患者病情恶化，两周后在家中死亡。据我们所知，这是首例子宫恶性混合性苗勒管肿瘤发生支气管内转移的病例。
