Very-Late Endobronchial Metastasis of Clear-Cell Renal Cell Carcinoma Occurring nearly 14 Years After Radical Nephrectomy: A Case Report

Endobronchial metastases (EBM) from renal cell carcinoma is rare in clinical practice, accounting for approximately 1.1% of all endobronchial malignant tumors. Herein we report a case of EBM from clear-cell renal cell carcinoma occurring in a 79-year-old man who underwent radical nephrectomy for primary clear-cell renal cell carcinoma nearly 14 years ago. The patient presented with recurrent cough and expectoration, and chest Computed Tomography (CT) indicated a central pulmonary mass. Pathological examination of bronchoscopic biopsy specimens confirmed EBM from clear-cell renal cell carcinoma. Comprehensive systemic imaging examinations including contrast‑enhanced chest‑abdominal‑pelvic CT, brain magnetic resonance imaging (MRI) and bone scan identified the isolated EBM metastatic lesion, without distant metastases in other organs. The patient’s Eastern Cooperative Oncology Group (ECOG) performance status was 2 at recurrence. According to the International Metastatic Renal‑Cell Carcinoma Database Consortium (IMDC) criteria, the patient had one adverse prognostic risk factors and was categorized into the “intermediate‑risk” group. The patient was then treated with axitinib and toripalimab, following multidisciplinary discussion. At the time of last follow-up, he had been treated with this regimen for 8 months. The treatment was well‑tolerated. Radiographic assessment according to Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 showed stable disease (SD) with reduction in lesion size. This case highlights that for patients with a prior history of renal cell carcinoma, newly detected central pulmonary lesions accompanied by respiratory symptoms should raise clinical suspicion for EBM of renal cell carcinoma, even many years after radical nephrectomy.