A Rare Case of Colon Adenocarcinoma Metastases to the Trachea: A Case Report

Primary tracheal malignancies are rare, and nonpulmonary metastasis to the trachea is exceedingly rare. Computed tomography (CT) imaging may not detect small or submucosal lesions, especially if performed without contrast. We present a rare case of metastasis of colorectal adenocarcinoma to the trachea and left mainstem bronchus 10 years after the initial cancer diagnosis. A 75-year-old man presented with a one-month history of globus sensation, a perception of an object ball-valving in his chest, and the ability to produce an audible noise with forced exhalation. He had a history of stage IV (T3N0) colon cancer that was diagnosed 10 years prior. He subsequently underwent a right colectomy and was disease-free for five years, at which time he had an isolated pulmonary metastasis. A left upper lobectomy was performed. A flexible fiberoptic laryngoscopy was performed in the office, and a small, nonraised epiglottic lesion was observed. The reported audible noise upon exhalation was also appreciated. CT chest imaging revealed an intraluminal tracheal lesion. The patient was taken to the operating room for a microsuspension direct laryngoscopy and bronchoscopy with biopsies. Three tracheal and left mainstem bronchus lesions were removed and final pathology demonstrated moderately differentiated adenocarcinoma. Although extraordinarily rare, tracheal malignancies and metastases should remain in the differential during the workup of a patient with globus sensation. Additionally, further workup with imaging and direct visualization in the operating room is of the utmost importance in patients with a history of malignancy.