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Zhang Z, Yu Y, Xie T, Qi C, Zhang X, Shen L, Peng Z. Pulmonary lymphangitis carcinomatosis: A peculiar presentation clustering in MET-amplified gastric cancer. Cancer Med 2023; 12:19583-19594. [PMID: 37772487 PMCID: PMC10587944 DOI: 10.1002/cam4.6575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The clinicopathological features of MET-amplified gastric cancer (GC) and real-world data on the efficacy of MET-targeted therapies remain unknown. Pulmonary lymphangitis carcinomatosis (PLC) is a peculiar manifestation of GC, whose management has not been thoroughly described. METHODS This study analyzed patients diagnosed with MET-amplified GC or GC with PLC at any time point of the disease course from 2011 to 2021 in two centers. Clinicopathological features and survival outcomes of MET-amplified GC were analyzed. The clinical and molecular implications of GC with PLC were discussed. RESULTS Fifty-eight patients with MET-amplified GC and 20 patients with GC accompanied by PLC were finally enrolled for analysis (including 13 overlapped patients). GC with PLC was more common in female patients (p = 0.010), diagnosed at a younger age (p = 0.002), presented with a higher baseline ECOG PS (p = 0.016), and was more likely to develop lung metastasis (p < 0.001), and serous effusion (p = 0.026) than GC without PLC. Patients with primary MET-amplified GC had a worse prognosis than those with secondary MET-amplified GC (p = 0.005). The application of anti-MET therapy was associated with numerically prolonged survival, but the association was not statistically significant (p = 0.07). MET amplification was concentrated in patients with PLC, in which anti-MET therapies elicited a high response rate. CONCLUSIONS MET-targeted therapies are efficacious in real-world populations with MET-amplified GC. Patients with PLC have distinct clinical and molecular features and might benefit from MET-targeted therapies.
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Affiliation(s)
- Zhening Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Yiyi Yu
- Fudan Zhongshan Cancer CenterZhongshan Hospital Fudan UniversityShanghaiChina
| | - Tong Xie
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Changsong Qi
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Xiaotian Zhang
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Lin Shen
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal OncologyPeking University Cancer Hospital & InstituteBeijingChina
| | - Zhi Peng
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal OncologyPeking University Cancer Hospital & InstituteBeijingChina
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2
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Corredor-Orlandelli D, Vargas L. Lymphangitic carcinomatosis as the initial manifestation of primary signet-ring cell adenocarcinoma of the lung: A case report. Rare Tumors 2023; 15:20363613231164017. [PMID: 36937819 PMCID: PMC10014970 DOI: 10.1177/20363613231164017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
Signet-ring cell carcinomas are an aggressive, poorly differentiated, and highly invasive adenocarcinoma carrying a poor prognosis. Most of these tumors originate in gastrointestinal organs; however, primary lung signet-ring cell adenocarcinomas can rarely occur. Tumoral lymphatic infiltration is a complication of these tumors and can cause phenomena such as lymphangitic carcinomatosis, characterized by a nodular thickening of the pleura, pleural effusions, and mediastinal lymphadenopathies. We report a case of a 63-year-old ex-smoker with a 2-week clinical course of dyspnea and pleuritic chest pain in which a nodular thickening of the pleura and pleural effusion were documented and led to the diagnosis of a primary signet-ring cell adenocarcinoma of the lung with lymphangitic carcinomatosis. This complication has never been described in the context of a primary lung tumor of this subtype. Both entities carry a high mortality and have no therapeutical options. This report adds to the information available about them.
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Affiliation(s)
- David Corredor-Orlandelli
- School of Medicine and Health
Sciences, Universidad del Rosario, Bogotá, Colombia
- David Corredor-Orlandelli, School of
Medicine and Health Sciences, Universidad del Rosario, Carrera 24 #63C-69,
Bogotá 110111, Colombia.
| | - Lina Vargas
- Internal Medicine Department, Fundación Cardioinfantil -
LaCardio, Bogotá, Colombia
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3
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Deicke M, Alhuneafat L, Obaid O, Adeniyi A, Raina A, Kassis‐George H. Rapidly progressive pulmonary hypertension and right ventricular failure in a heart and kidney transplant recipient. Clin Case Rep 2022; 10:e6631. [PMID: 36483880 PMCID: PMC9723255 DOI: 10.1002/ccr3.6631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
A 54-year-old man status post heart and kidney transplant presented with dyspnea. Imaging was consistent with lymphangitic carcinomatosis (LC), in the setting of biopsy proven adenocarcinoma. He developed pulmonary hypertension (PH) and died of right ventricular failure (RVF) 3 weeks later. Acute PH with radiographic features of LC in a high-risk patient warrants expedited malignancy investigation.
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Affiliation(s)
- Matthew Deicke
- Department of Internal Medicine, Allegheny Health NetworkAllegheny General HospitalPittsburghPennsylvaniaUSA
| | - Laith Alhuneafat
- Department of Internal Medicine, Allegheny Health NetworkAllegheny General HospitalPittsburghPennsylvaniaUSA
| | - Omar Obaid
- Department of CardiologySt. Mary Medical CenterHobartIndianaUSA
| | - Aderonke Adeniyi
- Alice Hyde Medical CenterUniversity of Vermont Health NetworkMaloneNew YorkUSA
| | - Amresh Raina
- Section of Advanced Heart Failure and Pulmonary HypertensionCardiovascular Institute, Allegheny Health Network, Allegheny General HospitalPittsburghPennsylvaniaUSA
| | - Hayah Kassis‐George
- Section of Advanced Heart Failure and Pulmonary HypertensionCardiovascular Institute, Allegheny Health Network, Allegheny General HospitalPittsburghPennsylvaniaUSA
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4
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Khader A, Braschi-Amirfarzan M, McIntosh LJ, Gosangi B, Wortman JR, Wald C, Thomas R. Importance of tumor subtypes in cancer imaging. Eur J Radiol Open 2022; 9:100433. [PMID: 35909389 PMCID: PMC9335388 DOI: 10.1016/j.ejro.2022.100433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/25/2022] [Indexed: 12/22/2022] Open
Abstract
Cancer therapy has evolved from being broadly directed towards tumor types, to highly specific treatment protocols that target individual molecular subtypes of tumors. With the ever-increasing data on imaging characteristics of tumor subtypes and advancements in imaging techniques, it is now often possible for radiologists to differentiate tumor subtypes on imaging. Armed with this knowledge, radiologists may be able to provide specific information that can obviate the need for invasive methods to identify tumor subtypes. Different tumor subtypes also differ in their patterns of metastatic spread. Awareness of these differences can direct radiologists to relevant anatomical sites to screen for early metastases that may otherwise be difficult to detect during cursory inspection. Likewise, this knowledge will help radiologists to interpret indeterminate findings in a more specific manner. Tumor subtypes can be identified based on their different imaging characteristics. Awareness of tumor subtype can help radiologists chose the appropriate modality for additional imaging workup. Awareness of differences in metastatic pattern between tumor subtypes can be helpful to identify early metastases.
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Affiliation(s)
- Ali Khader
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Marta Braschi-Amirfarzan
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Lacey J. McIntosh
- University of Massachusetts Chan Medical School/Memorial Health Care, Division of Oncologic and Molecular Imaging, 55 Lake Avenue North, Worcester, MA 01655, the United States of America
| | - Babina Gosangi
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, the United States of America
| | - Jeremy R. Wortman
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Christoph Wald
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Richard Thomas
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
- Correspondence to: Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, the United States of America.
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5
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Hryniewicki AT, LaFree A. An Immaculate Deception: Persistently Elevated Serum β-Hcg in Metastatic Signet Ring Cell Gastric Adenocarcinoma. J Emerg Med 2022; 62:475-479. [PMID: 35236614 DOI: 10.1016/j.jemermed.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Persistent elevations in beta-human chorionic gonadotropin (β-hCG) can be an ominous sign of both trophoblastic and non-trophoblastic malignancies. The absence of a clearly identified etiology of β-hCG elevation warrants pursuit of further diagnostic testing to determine the source of ectopic β-hCG. CASE REPORT A virginal 26-year-old woman with past medical history significant for persistently elevated β-hCG presented to our Emergency Department with shortness of breath, pleuritic chest pain, nausea, and vomiting, and was found to have widely metastatic gastric signet ring cell adenocarcinoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although elevated serum β-hCG is a generally a marker of pregnancy, β-hCG elevation without clear etiology necessitates ruling out other insidious processes. Failure to maintain and pursue a broad differential in the context of unexplained elevations of β-hCG can result in catastrophic missed or delayed diagnosis.
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Affiliation(s)
- Adam T Hryniewicki
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Andrew LaFree
- Department of Emergency Medicine, University of California San Diego, San Diego, California
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6
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Carlicchi E, Gemma P, Poerio A, Caminati A, Vanzulli A, Zompatori M. Chest-CT mimics of COVID-19 pneumonia-a review article. Emerg Radiol 2021; 28:507-518. [PMID: 33646498 PMCID: PMC7917172 DOI: 10.1007/s10140-021-01919-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) emerged in early December 2019 in China, as an acute lower respiratory tract infection and spread rapidly worldwide being declared a pandemic in March 2020. Chest-computed tomography (CT) has been utilized in different clinical settings of COVID-19 patients; however, COVID-19 imaging appearance is highly variable and nonspecific. Indeed, many pulmonary infections and non-infectious diseases can show similar CT findings and mimic COVID-19 pneumonia. In this review, we discuss clinical conditions that share a similar imaging appearance with COVID-19 pneumonia, in order to identify imaging and clinical characteristics useful in the differential diagnosis.
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Affiliation(s)
- Eleonora Carlicchi
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy.
| | - Pietro Gemma
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy
| | - Antonio Poerio
- Radiology Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Antonella Caminati
- Respiratory Medicine and Semi-Intensive Therapy Unit, Respiratory Physiopathology and Pulmonary Haemodynamics Services, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Angelo Vanzulli
- Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Oncology and Hemato-Oncology Unit, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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7
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Shioya S, Masuda T, Iwamoto H, Yamaguchi K, Sakamoto S, Horimasu Y, Miyamoto S, Nakashima T, Fujitaka K, Hamada H, Hattori N. Pulmonary lymphangitic carcinomatosis from recurrent gastric cancer 19 years after primary resection: a case report. Clin J Gastroenterol 2021; 14:484-488. [PMID: 33453005 DOI: 10.1007/s12328-020-01315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Pulmonary lymphangitic carcinomatosis is one rare pattern of pulmonary metastases in advanced cancers. Gastric cancer is one of the most common forms of cancer that causes pulmonary lymphangitic carcinomatosis. However, recurrent gastric cancer presenting as pulmonary lymphangitic carcinomatosis after surgery is extremely rare. Furthermore, recurrence is usually observed within 5 years. We present the first case of pulmonary lymphangitic carcinomatosis in a patient with recurrent gastric cancer, 19 years after resection. In patients with a history of gastric cancer and the presence of interstitial shadow, pulmonary lymphangitic carcinomatosis should be considered in the differential diagnosis even if several years have passed since surgery.
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Affiliation(s)
- Sachiko Shioya
- Department of Respiratory Internal Medicine, Innoshima Ishikai Hospital, 1962 Innoshima-Nakanosho, Onomichi, 722-7221, Japan
| | - Takeshi Masuda
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Hiroshi Iwamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinjiro Sakamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasushi Horimasu
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Miyamoto
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Taku Nakashima
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazunori Fujitaka
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Hamada
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Noboru Hattori
- Department of Respiratory Internal Medicine, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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8
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Delays in Diagnosis of Pulmonary Lymphangitic Carcinomatosis due to Benign Presentation. Case Rep Oncol Med 2020; 2020:4150924. [PMID: 33299624 PMCID: PMC7707955 DOI: 10.1155/2020/4150924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/26/2019] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of lymphangitic carcinomatosis is challenging due to the manifestation of nonspecific symptoms and radiographic abnormalities that bear similarity to those of interstitial lung disease. Herein, we report the case of a 53-year-old woman diagnosed with lymphangitic carcinomatosis from metastatic gastric adenocarcinoma, 3 months after her initial presentation.
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9
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King DA, Pineda G, Jhun I, Fisher G. Marked Decrease in CA 19-9 Level Belies Rapidly Progressive Lymphangitic Carcinomatosis in a Case of Metastatic Pancreatic Cancer. J Pancreat Cancer 2020; 6:102-106. [PMID: 33269335 PMCID: PMC7703254 DOI: 10.1089/pancan.2020.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 11/12/2022] Open
Abstract
Background: The CA 19-9 tumor marker is commonly used alongside imaging to trend chemotherapy response in patients with pancreatic ductal adenocarcinoma. Presentation: We describe an unusual clinical case of metastatic pancreatic cancer who achieved a marked decline in CA 19-9 but paradoxically developed widespread pulmonary lymphangitic carcinomatosis leading to rapid clinical decline and death. Conclusions: This case highlights the limitations of using the CA 19-9 tumor marker in isolation.
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Affiliation(s)
- Daniel A King
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Gino Pineda
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Iny Jhun
- Department of Pathology, Stanford University, Stanford, California, USA
| | - George Fisher
- Division of Oncology, Department of Medicine, Stanford University, Stanford, California, USA
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10
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Lopez-Garcia CA, Garcia-Hernandez I, López-Sotomayor DM, Martínez-Amador C, Rodríguez-Prado A, Esteban-Zubero E, Alatorre-Jimenez MA, Dono A, Pérez-Saucedo JE. Metastatic colorectal micropapillary carcinoma presenting as lymphangitic lung carcinomatosis. Clin J Gastroenterol 2020; 14:193-197. [PMID: 33040282 DOI: 10.1007/s12328-020-01258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Pulmonary lymphangitic carcinomatosis denotes the infiltration of tumor cells into the lung parenchymal lymphatic channels. Breast, lung, stomach, and colon adenocarcinoma are the most common origin of this invasion pattern. The micropapillary variant of colorectal adenocarcinoma has a high rate of lymph node metastases and poor overall survival. A 49 year-old man with a 6 months history of persistent cough and a relevant occupational chemical exposure had a computed tomography that showed bilateral interstitial lung infiltrates. The lung biopsy demonstrated a micropapillary adenocarcinoma with diffusely obstruction of the lung parenchymal lymphatics. The immunohistochemistry confirmed a colorectal origin. The colonoscopy evidenced a mass with identical morphology. Colorectal micropapillary carcinoma with metastatic lung lymphangitic carcinomatosis can occur, as a persistent cough, as presenting symptom in extraordinarily rare cases. To the best of our knowledge, this is the first case of an alive patient with colorectal metastatic micropapillary carcinoma presenting with lymphangitic lung carcinomatosis.
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Affiliation(s)
- Carlos A Lopez-Garcia
- Tecnologico de Monterrey, Hospital San Jose, Tec Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Irean Garcia-Hernandez
- Tecnologico de Monterrey, Hospital San Jose, Tec Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Dulce María López-Sotomayor
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Claudia Martínez-Amador
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Alejandra Rodríguez-Prado
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Eduardo Esteban-Zubero
- Department of Emergency, Hospital San Pedro, Calle Piqueras, 98, 26006, Logroño, La Rioja, Spain
| | | | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center At Houston, Medical School, 6431 Fannin, Suite 7.146 Houston, Houston, TX, 77030, USA
| | - José Eduardo Pérez-Saucedo
- Tecnologico de Monterrey, Hospital San Jose, Tec Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México.
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11
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Whittington JR, Whitcombe DD, Eads LE, Jeffus SK, Quick CM, Wendel PJ, Magann EF. Signet Ring Cell Carcinoma with Lymphangitic Carcinomatosis in Pregnancy: A Case Report of an Unexpected Maternal Death and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1888-1891. [PMID: 31844036 PMCID: PMC6930696 DOI: 10.12659/ajcr.919412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cancer in pregnancy is extremely rare, and gastric cancers are rarer still. Diagnosis is difficult in pregnancy due to overlapping symptoms with pregnancy such as nausea, pain, anemia, and fatigue. CASE REPORT A 26-year-old G1 woman at 32 weeks gestation with a past medical history of systemic lupus erythematosus presented with new-onset chest pain and shortness of breath. Computed tomography of the chest, electrocardiogram, and echocardiogram were normal. Laboratory evaluation revealed thrombocytopenia, proteinuria of 480 milligrams, and normal complement. She delivered on hospital day 3 due to worsening chest pain. During cesarean delivery, the patient became hypotensive and hypoxic and required intensive care unit admission after a cesarean hysterectomy. On postoperative day 2 she had a pulmonary embolus and was started on therapeutic anticoagulation. She clinically improved until postoperative day 4, when she was found unresponsive with pulseless electrical activity. After 38 minutes of Advanced Cardiac Life Support, death was pronounced. An autopsy was performed and the cause of death found to be complications of multi-organ system involvement of adenocarcinoma with signet ring cell features. Lymphangitic carcinomatosis was noted throughout the lungs. CONCLUSIONS This patient had adenocarcinoma with signet ring cell features and associated lymphangitic carcinomatosis, which led to her postpartum death. Lymphangitic carcinomatosis is associated with an exceedingly poor prognosis, especially in pregnancy.
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Affiliation(s)
- Julie R Whittington
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dayna D Whitcombe
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lauren E Eads
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susanne K Jeffus
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Charles M Quick
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paul J Wendel
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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12
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Mendoza DP, Digumarthy SR. The added value of quantitative 18F-FDG-PET/CT parameters in the assessment of pulmonary lymphangitic carcinomatosis in lung cancer. J Thorac Dis 2019; 11:E239-E242. [PMID: 31903292 DOI: 10.21037/jtd.2019.10.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Dexter P Mendoza
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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13
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Wang Y, Su M, Li L. Pulmonary lymphangitic carcinomatosis without concurrent liver metastasis from colon cancer detected using 18F-FDG PET/CT: A case report. Medicine (Baltimore) 2019; 98:e17446. [PMID: 31593099 PMCID: PMC6799856 DOI: 10.1097/md.0000000000017446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE The infiltration of tumor cells to pulmonary lymphatic system, as known as pulmonary lymphangitis carcinomatosis (PLC), is a rare presentation of pulmonary metastases. PATIENT CONCERNS We reported a case of a 66-year-old man after surgery, chemotherapy, and radiation therapy for colon cancer. Two months after these therapies, the patient complained of nonproductive cough for 1 week. DIAGNOSES 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scanning revealed increased FDG uptake along the thickened bronchovascular bundles, in bilaterally scattered ground-glass opacities and in mediastinal lymphadenopathy. The transbronchial biopsy and pathological study confirmed the diagnosis of PLC. INTERVENTIONS Antineoplastic treatment (cetuximab) were administered after the patient was diagnosed with PLC. OUTCOMES The patient died of respiratory failure within 3 months after the onset of his symptom. LESSONS 18F-FDG PET/CT play an important role in identifying PLC, in selecting possible biopsy sites, and in accessing the extent of metastatic disease.
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14
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Jreige M, Dunet V, Letovanec I, Prior JO, Meuli RA, Beigelman-Aubry C, Schaefer N. Pulmonary Lymphangitic Carcinomatosis: Diagnostic Performance of High-Resolution CT and 18F-FDG PET/CT in Correlation with Clinical Pathologic Outcome. J Nucl Med 2019; 61:26-32. [PMID: 31227574 DOI: 10.2967/jnumed.119.229575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
The rationale of this study was to investigate the performance of high-resolution CT (HRCT) versus 18F-FDG PET/CT for the diagnosis of pulmonary lymphangitic carcinomatosis (PLC). Methods: In this retrospective institution-approved study, 94 patients addressed for initial staging of lung cancer with suspicion of PLC were included. Using double-blind analysis, we assessed the presence of signs favoring PLC on HRCT (smooth or nodular septal lines, subpleural nodularity, peribronchovascular thickening, satellite nodules, lymph node enlargement, and pleural effusion). 18F-FDG PET/CT images were reviewed to qualitatively evaluate peritumoral uptake and to quantify tracer uptake in the tumoral and peritumoral areas. Histology performed on surgical specimens served as the gold standard for all patients. Results: Among 94 included patients, 73% (69/94) had histologically confirmed PLC. Peribronchovascular thickening, lymph node involvement, and increased peritumoral uptake were more often present in patients with PLC (P < 0.009). Metabolic variables, including tumor SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis, as well as peritumoral SUVmax, SUVmean, and their respective ratios to background, were significantly higher in the PLC group than in the non-PLC group (P ≤ 0.0039). Sensitivity, specificity, and area under the receiver-operating-characteristic curve for peribronchovascular thickening (69%, 83%, and 0.76, respectively; 95% confidence interval [95%CI], 0.67-0.85) and increased peritumoral uptake (94%, 84%, and 0.89, respectively; 95%CI, 0.81-0.97) were similar (P = 0.054). For detecting PLC, sensitivity, specificity, and area under the receiver-operating-characteristic curve were significantly higher, at 97%, 92%, and 0.98, respectively (95%CI, 0.96-1.00), for peritumoral SUVmax and 94%, 88%, and 0.96, respectively (95%CI, 0.92-1.00), for peritumoral SUVmean (all P ≤ 0.025). Conclusion: Qualitative evaluation of 18F-FDG PET/CT and HRCT perform similarly for the diagnosis of PLC, with both being outperformed by 18F-FDG PET/CT quantitative parameters.
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Affiliation(s)
- Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Igor Letovanec
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
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15
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Klimek M. Pulmonary lymphangitis carcinomatosis: systematic review and meta-analysis of case reports, 1970-2018. Postgrad Med 2019; 131:309-318. [PMID: 30900501 DOI: 10.1080/00325481.2019.1595982] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pulmonary lymphangitis carcinomatosis (PLC) is a life-threating complication in patients suffering from malignancies. Misleading and nonspecific symptoms often result in a delayed diagnosis. This review was aimed at evaluating epidemiology, clinical manifestations, and survival of patients with PLC reported in the literature. According to our knowledge, this study is the first such extensive analysis of PLC. We searched for the literature in the PubMed database for articles published from 1970 to 2018 using keywords: lung, pulmonary, lymphangitic, carcinoma, carcinomatosis. Pulmonary lymphangitis carcinomatosis rarely occurs, thus all data were extracted from case reports and case series consisted of a method for identifying individual-level patient data. In the final analysis, 108 articles (139 individual patient cases) were included. The mean age of PLC occurrence is 49.21 years. There is no difference in the prevalence between men and women. The most common underlying primary tumors coexisting with PLC are breast (17.3%), lung (10.8%), and gastric cancers (10.8%). Dyspnea and dry cough were the most common symptoms occurring in 59.0% and 33.8% of patients, respectively. In half the patients, PLC developed in fewer than ten months after first diagnosis of cancer. Pulmonary lymphangitis carcinomatosis diagnosis is associated with a poor prognosis: approximately half of patients die within two months of their first respiratory symptoms and three weeks from admission to hospital. Regarding survival time, we observed better results achieved in patients described between 2000 and 2018 compared to 1970 through 1999. In the presence of progressive dyspnea, cough, and lesions comparable to interstitial lung disease, diagnosis of PLC should be considered. Pulmonary lymphangitis carcinomatosis can be the first manifestation of primary occult neoplasm and may occur at any age. Adenocarcinoma, especially primary lung, breast, and gastric cancers is the most common cancer coexisting with PLC.
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Affiliation(s)
- Monika Klimek
- a Department of Laboratory Diagnostics , Medical University of Lublin , Lublin , Poland
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16
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Belhassine M, Papakrivopoulou E, Venet C, Mestdagh C, Schroeven M. Gastric adenocarcinoma revealed by atypical pulmonary lymphangitic carcinomatosis. J Gastrointest Oncol 2018; 9:1207-1212. [PMID: 30603143 DOI: 10.21037/jgo.2018.07.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Pulmonary lymphangitic carcinomatosis (PLC) is a well-known form of tumour metastasis to the pulmonary lymphatic system or to the adjacent interstitial tissue resulting in thickening of the bronchovascular bundle and septa. Another type of tumour metastasis to the lung involves the pulmonary vascular system and is known as pulmonary tumour thrombotic microangiopathy (PTTM). In this article, we will describe the unusual case of a young Chinese woman with gastric adenocarcinoma revealed by atypical radiographic lesions consistent with both PLC and PTTM. We will discuss the existing evidence and hypotheses about the pathophysiology of both conditions.
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Affiliation(s)
- Maia Belhassine
- Department of Pulmonary Medicine, Clinique Saint Jean, Brussels, Belgium
| | | | - Christian Venet
- Department of Radiology, Clinique Saint Jean, Brussels, Belgium
| | - Carole Mestdagh
- Department of Pathology, Clinique Saint Jean, Brussels, Belgium
| | - Marc Schroeven
- Department of Pulmonary Medicine, Clinique Saint Jean, Brussels, Belgium
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17
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Davis K, Bellizzi AM, Chan CHF. An Unusual Progression of Signet-Ring Cell Carcinoma of the Appendix in a Caucasian Woman. J Gastrointest Cancer 2017; 50:331-333. [PMID: 29043541 DOI: 10.1007/s12029-017-0018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katelynn Davis
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.,Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew M Bellizzi
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Carlos H F Chan
- Department of Surgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA. .,Division of Surgical Oncology and Endocrine Surgery, University of Iowa Hospital and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
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18
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Bhattacharya PK, Jamil M, Khonglah Y, Roy A, Subrahmanya MV. A Rare Case of Pulmonary Lymphangitic Carcinomatosis in a Young Adult with Carcinoma Stomach. J Clin Diagn Res 2017; 11:OD07-OD09. [PMID: 28969184 DOI: 10.7860/jcdr/2017/27352.10397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
Pulmonary Lymphangitic Carcinomatosis (PLC) occurs in about 6-8% of patients with lung metastasis and may rarely develop in the course of gastric cancer representing a complication due to diffuse metastasis in the lymphatics of the lungs. A 29-year-old female, admitted with difficulty in breathing and productive cough for one week, was initially evaluated for respiratory tract infection. During evaluation of associated anaemia an upper gastrointestinal endoscopy showed large ulcerative growth in the lesser curvature of the stomach suggestive of carcinoma. A High Resolution Computed Tomographic (HRCT) scan of the lungs was done for evaluation of the pulmonary opacities on chest x-ray which showed nodular thickening of interlobular septa with peribronchial cuffing and fissural thickening. The biopsy of the gastric ulcer was suggestive of poorly differentiated malignancy. With the cumulative results of the investigations a diagnosis of poorly differentiated carcinoma of stomach with pulmonary metastasis as lymphangitic carcinomatosis was made. PLC is an extremely rare manifestation of metastatic gastric cancer. Though associated with an extremely poor prognosis, advanced gastric cancer in younger patients presenting with symptoms and signs of respiratory disease should alert the physician of a possible diagnosis of PLC.
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Affiliation(s)
- Prasanta Kumar Bhattacharya
- Professor and Head, Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Md Jamil
- Assistant Professor, Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Yookarin Khonglah
- Associate Professor, Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Aakash Roy
- Postgraduate Student, Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Murti V Subrahmanya
- Postgraduate Student, Department of General Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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19
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Ağca M, Akyıl FT, Hörmet M, Akman O, Akman C, Şen A, Sevim T. A Rare Case of Progressive Dyspnea and Bilateral Lung Infiltration in a Young Male. Turk Thorac J 2017; 18:96-99. [PMID: 29404170 DOI: 10.5152/turkthoracj.2017.16052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/10/2017] [Indexed: 11/22/2022]
Abstract
Pulmonary lymphangitic carcinomatosis (PLC) is defined as infiltration of the lymphatic vessels and perilymphatic connective tissue with tumor cells, which is secondary to malignancy. Therefore, it rarely appears as an initial finding preceding a diagnosis of malignancy. A 30-year-old male patient was hospitalized in our clinic with a pre-diagnosis of interstitial lung disease owing to the complaints of dry cough, progressive dyspnea, and acute respiratory insufficiency. He was diagnosed with signet ring cell carcinoma, which is a histologic subtype of adenocarcinoma, via gastroscopy, and lung involvement was consistent with PLC. Regardless of the patient age, PLC should be considered in differential diagnoses of progressive dyspnea, acute respiratory failure, and widespread interstitial lung involvement.
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Affiliation(s)
- Meltem Ağca
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Fatma Tokgöz Akyıl
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Merve Hörmet
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Oğuzhan Akman
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Canan Akman
- Department of Radiology, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ayçim Şen
- Clinic of Pathology, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Tülin Sevim
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
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20
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Interstitial lung disease pattern turned out to be a predominantly lepidic lung adenocarcinoma. Respir Med Case Rep 2017; 21:56-58. [PMID: 28393007 PMCID: PMC5377009 DOI: 10.1016/j.rmcr.2017.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 11/21/2022] Open
Abstract
We report a case of a 46-year-old woman without any medical history who presented to our Respiratory Department with exertional dyspnoea for the last 6 weeks associated with non-productive cough. Chest radiography showed bilateral diffuse interstitial opacity. Bronchoalveolar lavage and transbronchial biopsies performed during flexible bronchoscopy as a step in the diagnostic workup of idiopathic interstitial pneumonia showed cells of pulmonary adenocarcinoma.
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21
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Khachekian A, Shargh S, Arabian S. Pulmonary Lymphangitic Carcinomatosis From Metastatic Gastric Adenocarcinoma: Case Report. J Osteopath Med 2015; 115:332-7. [DOI: 10.7556/jaoa.2015.064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Pulmonary lymphangitic carcinomatosis (PLC) is the diffuse infltration of lymphatic systems by adenocarcinomas. Because of its vague clinical symptoms and absence of malignant features, confrmatory diagnosis requires transbronchial or open-lung biopsy. Tumor spread is postulated to occur by means of retrograde lymphatic permeation with tumor growth along the lymphatic channels and involvement of vascular endothelial growth factor-C in a signaling pathway. The authors describe the case of a 45-year-old woman whose presentation with cough and dyspnea led to diagnosis of pulmonary lymphangitic carcinomatosis with superimposed pulmonary hypertension, tumor thrombotic microangiopathy, and ultimately metastatic signet ring cell gastric adenocarcinoma. Because of the patient’s poor prognosis, she was given palliative care and died 29 days after admission. This case emphasizes the importance of the osteopathic principle of treating the whole patient and evaluating all organ systems. Physicians should be aware of PLC from gastric adenocarcinoma and consider it in patients with pulmonary symptoms who are unresponsive to antibiotics.
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22
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A 50-year-old man with cirrhosis and progressive hypoxemia. Ann Am Thorac Soc 2014; 11:1149-51. [PMID: 25237994 DOI: 10.1513/annalsats.201405-211cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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