Kolon Kanseri Hastasında Bilateral Endobronşiyal Obstruktif Metastaz: Olgu Sunumu

Akciğer metastazı sık olarak görülmesine rağmen, endobronşiyal metastaz (EBM) seyrektir. Kolon kanserine bağlı bilateral EBM nadir bir durum olması nedeniyle sunuldu. Altmışiki yaşında erkek hasta, 3 aydır olan öksürük, nefes darlığı, hemoptizi şikayeleriyle başvurdu. Kırk paket yıl sigara kullanımı, 12 yıl önce kolon kanseri nedeniyle operasyon ve adjuvan kemoterapi öyküsü mevcuttu. Direkt akciğer grafisinde sağ akciğerde havalanma yoktu, sağ hemitoraksta homogen opasite ve trakeada sağa deviasyon vardı. Fiberoptik bronkoskopide (FOB) sağ ana bronşu tıkayan endobronşiyal tümöral lezyon ile sol ana bronşda ve sol alt lob bronşunda tümöral lezyon görüldü. Sağ ana bronşdaki kitleden alınan biyopsi materyalinin immunhistokimyasal çalışılmasında, tümöral alanların CK20 ve CDX2 ile boyandığı, CK7 ve TTF1 ile boyanmadığı görüldü ve histopatolojik bulgular kolon adenokarsinom metastazı ile uyumlu olarak değerlendirildi. Sağ akciğer ve mediastene yönelik palyatif 3600 cGY radyoterapi (RT) uygulandı. Hastaya metastatik kolon kanseri ve K-ras wild tip olması nedeniyle FOLFİRİ-Setuksimab kemoterapisi başlandı.

Bilateral Endobronchial Obstructive Metastases in a Patient with Colon Cancer: A Case Report

Although lung metastasis is frequent, endobronchial metastasis (EBM) is rare. We are presenting a case of colon cancer related bilateral EBM since it is rare. A sixty-two year old male patient was admitted with complaints of cough, respiratory distress and haemoptysis continuing for 3 months. He had a history of smoking 40 packages in a year, an operation due to colon cancer 12 years previously and adjuvant chemotherapy. Right pulmonary aeration was not observed in the direct pulmonary graphy, homogeneous opacity was detected in the right hemithorax and deviation to right was observed in the trachea. Fiberoptic bronchoscopy (FOB) revealed an endobronchial tumoral lesion obstructing the right main bronchus and tumoral lesions in the left main bronchus and the bronchus of the inferior left lobe. It was observed in an immunohistochemical study of the biopsy material, obtained from the mass within the right main bronchus, that the tumor sites were stained with CK20 and CDX2, and not stained with CK7 or TTF1. Histopathological findings were evaluated and found to be compatible with colon adenocarcinoma metastasis. Paliative 3600 cGY radiotherapy (RT) was performed on the right lung and mediastinum. FOLFIRI-Setuximab therapy was started since the metastatic colon cancer was of the K-ras wild type.

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