Endobronchial Metastasis with Extension to the Left Atrium from Adenocarcinoma of Gastric - Case Report - 69-year-old male response to chemoradiotherapy

Sep 23, 2026

Endobronchial metastases extending to the heart from gastric cancer are rare. This case report describes a 69-year-old man treated in Shahrekord, Iran, who presented in 2022 with cough and haemoptysis after total gastrectomy and adjuvant chemotherapy for gastric adenocarcinoma three years earlier. Imaging and pathology confirmed endobronchial metastasis with extension to the left atrium. The patient responded well to chemoradiotherapy, maintaining a good quality of life.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

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Introduction

Case report

Presentation and prior treatment

Imaging and diagnostic workup

Treatment and follow-up

Discussion

SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL 2025;25:150–153 Scan the QR to view the full-text article on the journal website CASE REPORT Endobronchial Metastasis with Extension to the Left Atrium from Adenocarcinoma of Gastric 3 Years after Total Gastrectomy Behnam Shakerian a,*, Mohammad H. Mandegar b a Department of Cardiovascular Surgery, Shahrekord University of Medical Sciences, Shahrekord, Iran b Department of Cardiovascular Surgery, Tehran University of Medical Sciences, Tehran, Iran ABSTRACT Endobronchial metastases extending to the heart from gastric cancer are rare. This case report describes a 69-year-oldman who presented to a tertiary care hospital in Shahrekord, Iran, in 2022 with a history of cough and haemoptysis. He had previously undergone total gastrectomy and adjuvant chemotherapy for gastric adenocarcinoma three years earlier. Imaging and pathological evaluation conﬁrmed endobronchial metastasis with extension to the left atrium. The patient responded well to chemoradiotherapy, maintaining a good quality of life. Keywords: Bronchial Neoplasms; Heart Atria; Metastasis; Gastrectomy; Adenocarcinoma; Case Report; Iran 1. Introduction Metastasis is a leading cause of mortality in patients with malignant tumours. 1 Distinguishing between metastasis and primary bronchogenic carcinoma can be challenging based on radiological and clinical ﬁndings alone. Immunohistochemistry plays a crucial role in conﬁrming the diagnosis of endobronchial metastasis (EBM) following treatment for gastric adenocarcinoma. EBM is associated with a poor prognosis; however, a multidisciplinary approach can improve long-term survival. We report a case of gastric adenocarcinoma with metachronous endobronchial metastasis, which invaded the pulmonary vein and extended into the left atrium. This case highlights the importance of early diagnosis using bronchoscopy and echocardiography in patients presenting with respiratory symptoms after treatment for gastric adenocarcinoma. 2. Case report A 69-year-old male patient presented to a tertiary care hospital in Shahrekord, Iran, in 2022 with a 3-week history of cough and haemoptysis. He had undergone total gastrectomy 3 years earlier for poorly diﬀerentiated gastric adenocarcinoma (stage IIB: T3, N1, M0), followed by adjuvant chemotherapy with 5-ﬂuorouracil, leucovorin, oxaliplatin, and docetaxel. Physical examination was unremarkable. Blood tests revealed leukocytosis with neutrophilia. Echocardiography showed a large, lobulated mass involving the left atrium and extending into the middle and inferior pulmonary veins, suggestive of metastasis [Fig. 1A]. Chest computed tomography (CT) revealed reticular lymphangitic carcinomatosis, along with a soft tissue mass with irregular borders measuring 49 􀀂 76 mm, involving the right main bronchus and right pulmonary vein, extending into Received 7 April 2024; revised 17 September 2024; accepted 25 September 2024. Available online 20 March 2025 * Corresponding author. E-mail address: [behshakerian@yahoo.com](behshakerian@yahoo.com) (B. Shakerian). [https://doi.org/10.18295/squmj.10.2024.066](https://doi.org/10.18295/squmj.10.2024.066) 2075- 0528/© 2025 Published by Sultan Qaboos University Sultan Qaboos University Medical Journal. This is an open-access article under the CC BY-ND license ([https://creativecommons.org/licenses/by-nd/4.0/](https://creativecommons.org/licenses/by-nd/4.0/)). Fig. 1. Echocardiography (A) showing a large mass in the left atrium (arrows) and (B) after treatment showed resolution of the left atrial mass. Fig. 2. Axial chest computed tomography scan obtained at the pulmonary window of the lower region of the thorax (A) showing an ill-deﬁned mass measuring 49 􀀂 76 mm, encasing the right main bronchus and the right pulmonary vein and extends to the left atrium and (B) showing a mass measuring 16 􀀂 31 mm, encasing the right main bronchus after treatment. the left atrium [Fig. 2A]. Moderate pleural

FAQs

Why is this endobronchial metastasis diagnosis difficult in gastric cancer patients?

Radiological and clinical findings alone may be insufficient to distinguish metastasis from primary bronchogenic carcinoma. Immunohistochemistry is crucial to confirm endobronchial metastasis after prior gastric adenocarcinoma treatment.

How did the clinicians confirm the tumor originated from gastric adenocarcinoma?

Bronchoscopy and biopsy showed poorly differentiated adenocarcinoma consistent with metastasis. Immunohistochemistry was negative for TTF-1 and HER-2 and positive for CDX2, CK7, and CK20, supporting gastric origin.

What treatment was administered, and what was the outcome?

The patient declined surgical resection and received weekly 24-hour infusions of cisplatin and 5-fluorouracil for six cycles with concurrent chest radiation (50.4 Gy). Follow-up echocardiography showed resolution of the left atrial mass after six months, and the patient remained asymptomatic at 12 months despite residual tumor.

Sep 23, 2026

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