Adjuvant Treatment of Proper Endobronchial Management in Leiomyosarcoma
A 49-year-old female visited our hospital complaining of a painful mass in the right buttock and dyspnea. One month earlier, she had been diagnosed with leiomyosarcoma after excision of a mass in the right suprapubic area. Positron emission tomography-computed tomography (PET-CT) revealed metastases to the gluteal muscles and lungs.\nPalliative chemotherapy was recommended after the surgical excision because of the severe hip pain. Meanwhile a chest radiograph revealed haziness of the left hemithorax suggesting atelectasis of the left lung (). Bronchoscopy disclosed a huge encapsulated mass involving the left main bronchus ().\nThe tumor was removed bronchoscopically using a snare (Force FX TM-8C; Valley Lab, Boulder, CO, USA) and cryoextraction. A 5-cm encapsulated mass was extracted with a flexible cryoprobe (Erbokryo CA; ERBE Elektromedizin GmbH, Tübingen, Germany). After removing this huge mass, remnant tumor was seen in the left lower lobe. A chest radiograph after the bronchoscopic intervention showed improvement of the atelectasis (). Pathologic findings of endobronchial tumor showed a spindle cell neoplasm, which was consistent with metastatic leiomyosarcoma ().\nAfter recanalization of the left main bronchus via interventional bronchoscopy, the dyspnea disappeared and the patient received additional chemotherapy. Nevertheless, the endobronchial metastasis progressed and endobronchial obstruction recurred at the same site 4 months later. Interventional bronchoscopy for debulking was repeated, which relieved her symptoms, except mild nonspecific chest discomfort. The patient did not want further chemotherapy because of progression of the underlying leiomyosarcoma. She discharged to palliative care.