Atypical Manifestations of Primary Pulmonary Adenocarcinoma With Signet Ring Features: A Case Report.

Primary pulmonary malignancies are one of the most common malignancies worldwide. The most common non-small cell lung malignancy is adenocarcinoma, but there are many subtypes with different molecular and genetic expressions causing different manifestations. Uncommon manifestations include persistent back pain and tracheal bronchial tumors. More than 95% of reported tracheal bronchial tumors are benign and thus are rarely biopsied. There are no reported cases of secondary tracheal bronchial tumors due to pulmonary adenocarcinoma. Today, we are reporting the first case report of an uncommon manifestation of primary pulmonary adenocarcinoma.

Fibrobronchoscopic cryosurgery for secondary malignant tumors of the trachea and main bronchi.

BACKGROUND: Patients with secondary malignant tracheal and main bronchial tumors may suffer severe symptoms as a result of major airway obstruction. Curative surgical resection is usually not suitable because of the presence of metastatic disease and poor performance status. In this study, the use of bronchoscopic cryosurgery to reopen the airway is analyzed. METHODS: The clinical records of 37 patients who experienced secondary maglinancies from December 2001 to January 2013 were retrospectively reviewed. Low temperature cryotherapy (-50°C to -70°C) was delivered to the central part of the tumor by cryoprobe for four to six minutes causing destruction of the tumor mass (Cryo-melt method). Subsequently, the edge of the tumor was frozen for 30 seconds to two minutes, followed by piecemeal removal of the frozen tumor tissue (Cryo-resection method). RESULTS: The endpoints of the study were degree of symptomatic improvement and survival. The rates of dramatic and partial symptomatic alleviation were 57.1% and 28.6%, respectively, there were no intraoperative deaths, and median survival was 16.0 months. Prolonged survival was significantly correlated to age (under 60 years of age 22.2% vs. over 60 100%, P = 0.011), tumor location (main bronchi 0% vs. trachea 77.8%, P = 0.003), and cryorecanalization times (once 33.3% vs. twice or more 80.0%, P = 0.037). CONCLUSION: Bronchoscopic cryorecanalization is a safe, effective, non-invasive choice for improving the symptoms of malignant airway obstruction. In addition to achieving local-regional control, the technique may also contribute to improved survival.