Obstructive jaundice caused by lymphangitis carcinomatosa of bile duct wall from gastric carcinoma

Obstructive Jaundice as the Initial Manifestation of Gastric Adenocarcinoma

A 52-year-old female presented with epigastric pain, yellowing of the sclera, and vomiting for three weeks. Laboratory investigations revealed markedly elevated serum bilirubin and alkaline phosphatase levels, accompanied by a modest rise in transaminases. A clinical diagnosis of obstructive jaundice was established. Ultrasound of the abdomen depicted a mass in the region of the head of the pancreas. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an infiltrative gastric mass spreading across the gastroduodenal junction and involving the ampulla of Vater. Owing to comorbid conditions and widespread lymphadenopathy, a palliative gastrojejunostomy with excision biopsy was performed. Histopathology confirmed an undifferentiated gastric adenocarcinoma.

Intestinal lymphangitis carcinomatosa related to ovarian cancer: Case report and review of the literature

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Lymphangitis carcinomatosa is known as commitment of pulmonary lymph vessels.

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Intestinal lymphangitis carcinomatosa is rarely reported.

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This is the first report of intestinal lymphangitis related to ovary cancer.

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This is the first report of intestinal lymphangitis other than duodenal.

We present a 57-year-old woman with ovarian cancer that presented to the Emergency Room with a proximal small bowel obstruction. Exploratory laparotomy evidenced a thickened 10 cm extension of the proximal jejunum without bowel peristalsis, with stenotic enteric lumen, with a lesion apparently originating from its submucosal and muscular layers. The patient underwent an exploratory laparotomy with total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, small bowel resection and peritoneal biopsies. Final pathology and immunohistochemistry confirmed the intra-operative suspicion of lymphatic intestinal spread of malignant cells originating from a high grade serous carcinoma of ovarian origin. To the best of our knowledge, this is the first report in the literature of intestinal carcinomatous lymphangitis related to ovarian cancer, and the first report of involvement of the proximal portion of the jejunum.

Lymphangitic spread of invasive lobular carcinoma to the contralateral breast

Breast cancer typically spreads primarily to regional lymph nodes and subsequently to distant sites via hematogenous routes. Occasionally metastasis can occur through lymphangitic spread, usually to the lungs, resulting in lymphangitic carcinomatosis. Lymphangitic spread of several malignancies have been reported at other sites in the body with varying degrees of clinical significance. In this case report, we describe a rare case of lymphangitic spread of invasive lobular carcinoma to the contralateral breast identified on imaging as significant background enhancement without a discrete suspicious mass.

Poorly Differentiated Gastric Adenocarcinoma Can Mimic Hilar Cholangiocarcinoma

This report describes two cases with obstructive jaundice caused by poorly differentiated gastric adenocarcinoma. Computed tomography scans showed circumferential stenosis in the hilar bile ducts. Endoscopic retrograde cholangiopancreatography showed dilatation of the bilateral hepatic ducts and stenosis of the common hepatic ducts from the bifurcation of the bilateral hepatic ducts. The first diagnoses were hilar cholangiocarcinoma and biliary drainage decreased serum bilirubin; however, both patients died of cancer within a short period of time. Autopsies revealed lymphatic vessel invasion and possible subepithelial invasion by gastric adenocarcinoma into the hilar bile ducts. A differential diagnosis should thus be required in suspected cases of hilar cholangiocarcinoma.

Duodenal lymphangitis carcinomatosa: endoscopic characteristics and clinical significance

BACKGROUND AND AIM

Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa.

METHODS

Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined.

RESULTS

The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non-ulcerated mucosa upon thickening. The granularity seems to been caused by dilated lymph vessels containing the carcinoma cells. The lesions were microscopically characterized by: (i) involvement of lymph vessels located in the upper portion of the lamina propria; (ii) no inflammatory changes; and (iii) no desmoplastic changes. Primary sites were thought to be the stomach in case 1, the pancreas in cases 2 and 4, and unknown in case 3. All patients died within 6 months after admission or endoscopic examination.

CONCLUSIONS

As duodenal lymphangitis carcinomatosis shows characteristic endoscopic appearance, endoscopic diagnosis is not difficult. We should realize that the lesion represents extremely poor prognosis, and it should be distinguished from ordinary metastatic duodenal carcinoma.