To determine the clinical presentation of patients with malignancies m
etastatic to the lung, the diagnostic utility of fiberoptic bronchosco
py (FB), and the primary site of malignancies metastasizing endobronch
ially, we retrospectively reviewed 1,853 FB records (1987 to 1991) and
selected 111 cases for review Cases were divided on the basis of FB f
indings into abnormal (44 patients) and normal (67 patients). Pulmonar
y symptoms (cough, hemoptysis, and chest pain) prompted referral signi
ficantly more often in the abnormal FB group (34/44) than in the norma
l FB group (24/67). The finding of atelectasis on chest radiograph occ
urred more frequently in patients with endobronchial abnormalities. Th
e spectrum of extrapulmonary malignancies that metastasize endobronchi
ally has changed during the AIDS epidemic. Our study shows the most fr
equent causes of endobronchial mass lesions were Kaposi's sarcoma and
the lymphoma group (Hodgkin's disease, nonHodgkin's lymphoma, chronic
lymphocytic leukemia) and the most common malignancies causing submuco
sal metastases were breast and the lymphoma group. In summary, the hig
hest yield for FB can be expected in patients experiencing symptoms of
cough of hemoptysis and/or having radiographic evidence of atelectasi
s. We propose a new mnemonic ''KLAS'' (Kaposi's sarcoma, Lymphoma, Ade
nocarcinoma, Sarcoma) to describe the malignancies most likely to meta
stasize endobronchially in the 1990s.