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JAMA Oncology Clinical Challenge
September 10, 2020

Posterior Subglottic Mass in a Patient With a History of Rectal Adenocarcinoma and Lung Metastases

Author Affiliations
  • 1Otolaryngology Consultation Service, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
  • 2Developmental Therapeutics Clinic, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
JAMA Oncol. 2020;6(12):1967-1968. doi:10.1001/jamaoncol.2020.2693

The patient is a 48-year-old man with a history of a rectal adenocarcinoma (cT3N2bM0) diagnosed 9 years prior. Following neoadjuvant chemoradiotherapy, low anterior resection, and 6 cycles of adjuvant FOLFOX therapy (fluorouracil, leucovorin, and oxaliplatin), he had developed a lung metastasis (KRAS wild type) 1 year later. He subsequently developed multiple lung metastases treated with palliative local interventions (lobectomy, radiofrequency ablation) and 4 lines of chemotherapy. Owing to symptomatic lung disease, he was enrolled in a clinical trial (NCT03502733) following informed consent and achieved a confirmed partial response. After 9 months, contrast computed tomography restaging scans noted a new, 1-cm posterior subglottic lesion of unclear origin (Figure, A). He had no shortness of breath or noisy breathing, dysphagia, voice change, or hemoptysis. A partial response was maintained without evidence of progression of lung disease.

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