Adjuvant Treatment of Proper Endobronchial Management in Leiomyosarcoma
A 40-year-old male was admitted the orthopedics department complaining of a mass on the right thigh. He underwent wide excision of this and pathology confirmed the diagnosis of leiomyosarcoma. Postoperative radiotherapy followed. Since multiple lung metastases were observed on PET-CT 1 month after radiotherapy, palliative chemotherapy followed. A craniotomy with tumor removal was performed for brain metastasis 1 year later.\nOne month after the craniotomy, worsening dyspnea developed. Total collapse of the left lung was observed on chest radiography (). Bronchoscopy was performed and an endobronchial tumor was observed in the proximal left main bronchus (). The tumor had a smooth mucosal surface and protruded into the left upper lobe bronchus. The tumor was removed using a snare and cryoextraction (). This relieved the dyspnea and a chest radiograph showed improved aeration (). The pathologic specimen of bronchial tumor revealed metastatic leiomyosarcoma (). Subsequently, palliative chemotherapy with pazopanib was administered.\nFive months after administering the pazopanib, the patient developed dyspnea and chest discomfort during expiration or position change. His cough worsened and produced blood-tinged sputum. Chest CT revealed on increased mass obstructing the left main bronchus again. Bronchoscopic examination showed endobronchial tumors obstructing the distal left main bronchus and openings of the left upper and lower lobes. Bronchoscopic tumor removal was repeated using cryoextraction. After debulking therapy, the symptoms were relieved and the patient was given additional palliative pazopanib chemotherapy.