Isolated Endobronchial Metastasis of Breast Cancer Successfully Managed With Multimodal Treatment

Abstract

Isolated endobronchial metastases of breast cancers, without other visceral metastatic involvement, are exceptional. We report here an observation of isolated endobronchial metastasis discovered 18 months after complete treatment of breast carcinoma. The endobronchial metastasis was revealed by an incoercible cough and hemoptysis. A bronchoscopy revealed a budding tumor process obstructing the right stem bronchus and a biopsy was performed. The anatomopathological and immunohistochemical analysis confirmed the metastatic nature of the endobronchial tumor. The patient received treatment with palbociclib and aromatase inhibitors. Two years after radiotherapy and under hormone treatment, the patient is in complete remission of her breast cancer and endobronchial metastasis. Emerging research suggests that oligometastatic breast cancer carries a superior prognosis. We believe that patients with oligometastatic breast cancer should be treated with curative intent, including ablative therapy to all sites of disease if it can be safely accomplished. This approach may offer an additional chance for prolonged survival.

Keywords: breast cancer; case report; cdk4/6 inhibitor; endobronchial metastasis; multimodal treatment.

Figure 1. Chest CT scan showing a right lower lobe atelectasis.

Figure 2. Anatomopathological examination of the endobronchial mass showing poorly differentiated tumor proliferation with hematoxylin and eosin (H&E) staining at low (A) and high magnification (B).

Figure 3. Immunohistochemical study showing that tumor cells express cytokeratin AE1/AE3 (A), estrogen receptor (B), and progesterone receptor (C) but do not express thyroid transcription factor 1 (TTF-1) (D).

Figure 4. PET/CT scan showing high fluorodeoxyglucose uptake in the right lower lobe bronchus (maximum standard uptake value = 7.2) (A-D) with no other hypermetabolic sites (E).

Figure 5. Images showing radiotherapy plans.