==== Front Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 2465855710.5144/0256-4947.2014.68asm-1-68Brief ReportPrevalence of endobronchial metastases in lung cancer in Scotland Onuigbo Wilson From the Department of Pathology, Medical Foundation and Clinic, Enugu, NigeriaCorrespondence: Prof. Wilson Onuigbo, Department of Pathology, Medican Foundation and Clinic, Enugu 400001, Nigeria, T: +2348037208680, wilson.onuigbo@gmail.comJan-Feb 2014 34 1 68 69 Copyright © 2014, Annals of Saudi Medicine2014This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.BACKGROUND AND OBJECTIVES Endobronchial metastases are reported in patients suffering from lung cancer. The objective of this study was to determine the prevalence of this lesion in patients in Scotland. DESIGN AND SETTINGS Lung cancer patients autopsied personally at the Western Infirmary, Glasgow, Scotland, were examined regarding the primary lesion and its secondaries with special reference to the submucosa of the bronchus. PATIENTS AND METHODS A total of 100 patients had full records of their illness and the autopsy findings. RESULTS Four patients had lobectomy and were excluded from the series. Of the remaining 96 patients, 53 showed no endobronchial metastases, 26 exhibited bronchial sheathing, 10 manifested submucosal metastases, and the remaining 7 had both sheathing and submucosal metastases. CONCLUSION This study demonstrated that Scottish patients dying with lung cancer displayed endobronchial metastases at autopsy. This lesion and its benign counterparts are increasingly undergoing therapeutic management. ==== Body When tumor deposits occurred in the submucosa of the bronchus in cancer patients, the medical masters of old could not but be aware of them.1,2 In the well-couched words of Kidd,3 “The mucous membrane of the right bronchus was much thickened, and was beset with numerous firm miliary nodules.” Therefore, the prevalence of this local lesion was sought in a well-defined community. PATIENTS AND METHODS A total of 100 patients with lung cancer were diagnosed at the Western Infirmary, Glasgow, Scotland. All patients underwent autopsy with a particular reference to the primary growth and its relationship with the rest of the bronchus. The data were recorded for the Department of Pathology while the duplicate copies were kept personally. Apart from the vast majority that showed no remarkable features, sheathing of the bronchus was noted while its inner surface was described. For example, patient B 2448 was described as follows: “Outcrops of subcutaneous growths extend proximally for about 1 cm.” Patient B 3118 was described as follows: “There are outcrops of submucous deposits but scanty sheathing of the bronchus.” RESULTS Four patients underwent lobectomy and were excluded from the series. The remaining 96 patients were analyzed. As many as 53 patients showed no bronchial involvement. External sheathing of tumor tissue appeared in 26 cases. Ten patients revealed submucousal outcrops of metastatic cancer. The remaining 7 patients exhibited both sheathing and submucous metastasis. The occasional individual case manifested an unusual component. Thus, B 2454 was described as follows: “Submucous outgrowths reaching the carina and crossing over a little into the other bronchus.” Similarly, B 3597 was described as follows: “The main bronchus of the left lower lobe is ulcerated by tumor that also cuffs this bronchus. Tumor tissue extends proximally, and there are submucous outcrops that have coalesced together in the main left bronchus.” DISCUSSION Lung cancer is an intimidating disease worldwide, although it is not yet pronounced in my home country, Nigeria.4 During Residency Training in Glasgow, Scotland, I readily accumulated the series used in reporting the invasion of such diverse organs as the kidney,5 brain,6 adrenal gland,7 and, recently, the thoracic duct.8 Of course, these were all based on fatal cases. In contrast, ongoing work on the bronchus itself deals with the prospects of remedy. In this context, endobronchial metastases have gained keen recognition of late. Thus, from the University of California, San Diego, its workers concluded that “palliative endobronchial high-dose rate brachytherapy is a useful palliative modality in patients with recurrent endobronchial symptomatic carcinoma.” 9 On their own part, Shure and Astarita10 suggested performing 3 biopsies of endobronchial mass lesions to achieve an optimal diagnostic yield with minimal risk of bleeding. From India, Gupta et al11 reminded that, though malignant lesions are common, benign lesions remain important causes of intrabronchial mass lesions. On the success side, Simoff12 concluded the following firmly: “Endobronchial interventions are important adjuncts in the multimodality management of lung cancer and should become standard considerations in the management of patients with advanced lung cancer. For patients with respiratory symptoms associated with their disease, these interventions provide symptom palliation and improved quality of life.” There is also the angle that biopsy may well bring up surprises. In particular, tuberculosis may be unearthed and treated.13–15 Indeed, the lesion may be esoteric but treatable as in the case of zygomycosis for which amphotericin B is the answer.16 Acknowledgments I would like to thank late Professor Daniel Coppell, Head of the University Department of Pathology, Western Infirmary, Glasgow, Scotland, for the Residency Training that I underwent while holding a scholarship granted by the Government of Eastern Nigeria under the Nigeria/United Kingdom Technical Assistance Scheme. ==== Refs REFERENCES 1 Bristowe JS On some of the more uncommon features presented by cancer of the lung Trans Pathol Soc Lond 1860 11 25 35 2 Carrington RE Carcinoma of the thyroid gland Trans Pathol Soc Lond 1886 37 508 511 3 Kidd P A case of disseminated cancer Trans Pathol Soc Lond 1883 34 240 243 4 Onuigbo WIB Lung carcinoma in the Igbos Nig J Surg Sci 2007 17 21 24 5 Onuigbo WIB The spread of lung cancer to the kidneys Cancer 1958 11 737 739 13561241 6 Onuigbo WIB The spread of lung cancer to the brain Br J Tuberc Dis Chest 1958 52 141 148 13523167 7 Onuigbo WIB Lymphangiogenesis may explain adrenal selectivity in lung cancer metastases Med Hypotheses 2010 75 185 186 20303219 8 Onuigbo WIB Nature’s necrosis factor when associated with erythrocytes may not only explain the surprises in lung cancer metastasis but also suggest target therapy Med Hypotheses 2013 80 698 700 23528334 9 Seagrem SL Harrell JH Horn RA High dose rate intraluminal irradiation in recurrent endobronchial carcinoma Chest 1985 88 810 814 2415306 10 Shure D Astarita RW Bronchogenic carcinoma presenting as an endobronchial mass Chest 1983 83 865 867 6303712 11 Gupta S Bhalotra B Jain N Spectrum of intrabronchial mass lesions and role of flexible bronchoscopy in their diagnosis: A series of 74 cases Indian J Chest Dis Allied Sci 2010 52 79 82 20578399 12 Simoff MJ Endobronchial management of advanced lung cancer. Posted: 07/0½001 Cancer Control 2001 8 4 © 2001 H. Lee Moffit Cancer Center and Research Institute, Inc 13 Ip MSM Lam WK Mok CK Endobronchial tuberculosis revisited Chest 1986 89 727 730 3698702 14 Smith LS Schillaci RF Sarlin RF Endobronchial tuberculosis. Serial fiberoptic bronchoscopy and natural history Chest 1987 91 644 647 3105965 15 Volckaert A Roels P Niepen PV Schandevyl W Endobronchial tuberculosis: report of three cases Eur J Respir Dis 1987 70 99 101 3817077 16 Benbow EW Bonshek RE Stoddart RW Endobronchial zygomycosis Thorax 1987 42 553 554 3438900