Xie Tian-Hao, Fu Yan, Ha Si-Ning, Meng Qing-Xu, Sun Qian, Wang Pan
Department of General Surgery, The Affiliated Hospital of Hebei University, Baoding 071000, Hebei Province, China.
Department of Ophthalmology, Baoding First Central Hospital, Baoding 071000, Hebei Province, China.
World J Clin Cases. 2024 Aug 16;12(23):5416-5421. doi: 10.12998/wjcc.v12.i23.5416.
Endobronchial metastases (EBMs) are tumours that metastasise from a malignant tumour outside the lungs to the central and subsegmental bronchi, and are visible under a bronchofibrescope. Most EBMs are formed by direct invasion or metastasis of intrathoracic malignant tumours, such as lung cancer, oesophageal cancer or mediastinum tumours. Renal cell carcinoma (RCC), accounting for 2% to 3% of all tumours, is a common malignant tumour of the urinary system. Renal clear cell carcinoma (RCCC) constitutes the predominant pathological subtype of RCC, comprising approximately 70% to 80% of all RCC cases. RCCC can spread and metastasise through arterial, venous and lymphatic circulation to almost all organs of the body. Moreover, lung, bone, liver, brain and local recurrence are the most common metastatic neoplasms of RCCC. However, EBM from RCCC has a low complication rate and is often misdiagnosed as primary lung cancer.
A 71-year-old male patient who had undergone radical left nephrectomy 7 years prior due to RCCC was referred to our hospital due to a 1-mo history of productive cough. The results of an enhanced chest CT scan indicated the presence of a soft tissue nodule in the upper lobe of the left lung, and flexible bronchoscopy revealed a hypervascular lesion in the bronchus of the left lung's superior lobe. Therefore, the patient underwent thoracoscopic left superior lobe wedge resection, and pathology confirmed EBM from the RCCC.
EBM from RCCC has a low incidence and no characteristic clinical manifestations in the early stage. If a bronchial tumour is found in a patient with RCCC, the possibility of bronchial metastatic cancer should be considered.
支气管内转移瘤（EBMs）是指从肺外恶性肿瘤转移至中央和亚段支气管，且在纤维支气管镜下可见的肿瘤。大多数EBMs是由胸内恶性肿瘤，如肺癌、食管癌或纵隔肿瘤直接侵犯或转移形成。肾细胞癌（RCC）占所有肿瘤的2%至3%，是泌尿系统常见的恶性肿瘤。肾透明细胞癌（RCCC）是RCC的主要病理亚型，约占所有RCC病例的70%至80%。RCCC可通过动脉、静脉和淋巴循环扩散转移至身体几乎所有器官。此外，肺、骨、肝、脑及局部复发是RCCC最常见的转移瘤。然而，RCCC导致的EBM并发症发生率低，且常被误诊为原发性肺癌。
一名71岁男性患者，7年前因RCCC接受了根治性左肾切除术，因咳嗽咳痰1个月病史转诊至我院。胸部增强CT扫描结果显示左肺上叶有一个软组织结节，纤维支气管镜检查发现左肺上叶支气管有一个高血管病变。因此，患者接受了胸腔镜下左肺上叶楔形切除术，病理证实为RCCC导致的EBM。
RCCC导致的EBM发病率低，早期无特征性临床表现。RCCC患者若发现支气管肿瘤，应考虑支气管转移癌的可能性。
