Expectoration of a lung metastasis in a patient with colorectal carcinoma

Metastatic disease is present in up to 20% of patients at the time of diagnosis of colorectal cancer. The most frequently involved sites are the liver and the lungs. A rare form of lung metastatic disease is endobronchial metastases, most commonly seen with breast cancer and colon cancer. Their clinical and imaging profile is similar to primary bronchogenic carcinoma. Tumor expectoration is an unusual manifestation of endobronchial metastases (as well as of the primary lung carcinoma). We report the case of a 75-year-old man with known liver and lung metastatic disease from colon cancer who experienced an episode of tissue expectoration. Pathology examination of the expectorated piece of tissue was consistent with colonic adenocarcinoma. Tumor expectoration is a rare event, with < 30 cases reported in the literature. Most of the cases reported include secondary lung malignancies, with renal cell carcinoma being the most common primary site. Endobronchial metastases from colon cancer are rare. Patients with colon cancer can benefit from sputum cytology because this type of metastases is shown to have exfoliative properties. To assess the need for endobronchial management with stent placement or bracytherapy, bronchoscopy should be considered in certain circumstances (the onset of respiratory symptoms, rapid response to chemotherapy, long history of metastatic disease with multiple systemic therapies given, undulating response in tumor, as well as after a reported episode of tissue expectoration).