Endobronchial Metastasis from Rectal Adenocarcinoma without Liver Involvement: A Case Report

直腸癌病人術後多年後併發遠端肺支氣管內癌症轉移－案例報告

黃凱呈(Kai-Cheng Huang) ； 張高耀(Kao-Yao Chang)

《胸腔醫學》 24卷3期 (2009/06) Pp. 175-180

https://doi.org/10.29806/TM.200906.0008

摘要

肺部是常見的癌症轉移處，然而肺外腫瘤併發支氣管內轉移的個案機率卻是少見，尤其此類轉移的機轉與過程目前尚無定論。依目前所推論的癌症轉移路徑而言，原發大腸直腸惡性腫瘤應先轉移至肝臟，而後再由血液循環路線至肺內。本次報告一位男性直腸癌病人，於接受直腸切除手術及化學治療後，因疑似肺部感染症狀住院診察，最後診斷為直腸癌併支氣管內癌症轉移，但無肝臟轉移情形。因個案之肺部轉移病灶超過手術切除適應症（縱膈腔淋巴轉移），僅能接受放射治療緩解。本篇案例報告蒐集相關文獻，簡介此類病例之發生率、診斷方式、治療策略以及存活機會。

關鍵字

大腸直腸癌 ； 癌症轉移 ； 支氣管

並列摘要

The lungs are common sites for secondary metastases. However, endobronchial metastases from extrapulmonary primary sites are rare, and their definition and developmental modes have not yet been fully elucidated. The liver is the most common site of hematogenous spread from colon tumors, which then progresses to pulmonary sites. Herein, we report a case of adenocarcinoma of the rectum, status post-radical proctectomy and postoperative chemotherapy. After a 2-year disease-free interval, the patient was brought to the emergency department and hospitalized with pulmonary symptoms similar to pneumonia. Computed tomography disclosed lobar consolidation of the right upper lobe and obstruction of the right main bronchus. Metastatic lung cancer was confirmed with histopathology of a biopsy specimen obtained through bronchoscopy. Hematogenous dissemination was most likely because of the additional pulmonary nodule at the right lower lobe. Due to the tumor being unresectable, the patient received radiation therapy for palliative treatment. We also reviewed the literature on endobronchial colorectal metastasis. The median time of metastasis to the lung from the primary site at the colon is about 4 years, and treatment is variable on account of the individual condition.

並列關鍵字

colorectal ； endobronchial ； metastasis ； extrapulmonary