A Case of Rapidly Deteriorating Lymphangitic Carcinomatosis in a Patient with Stage IV Pancreatic Cancer

Abstract

Pulmonary lymphangitic carcinomatosis (PLC) is defined as a tumor in the lung lymphatic vessels. It is rarely seen as a result of malignancy and generally carries a poor prognosis. Proper knowledge of the clinical presentation is important for physicians to be aware of in order to consider a diagnosis of PLC. We present the case of a 52-year-old Caucasian gentleman who initially came to the hospital with a three-week history of dyspnea. In the hospital, a diagnosis of Stage 4 pancreatic cancer with a lymphangitic spread of the tumor to the lungs was made. Despite optimal treatment, the patient required mechanical ventilation for acute hypoxic respiratory failure. PLC is a relatively rare manifestation of malignancy; yet, it generally carries a poor prognosis. It may occur during the course of malignancy or may represent as the first findings in malignancy. It is important for physicians to be aware of the clinical presentations of PLC in order to ensure timely treatment. Oftentimes, PLC can be diagnosed through clinical judgment alone without the need for radiological support and other invasive measures.

Marked Decrease in CA 19-9 Level Belies Rapidly Progressive Lymphangitic Carcinomatosis in a Case of Metastatic Pancreatic Cancer

“…This patient developed widespread PLC in the absence of evidence of tumor emboli. PLC represents tumor in the lung lymphatic channels and is associated with invasion to the interstitium resulting in thickened septa, 15 , 16 which was the likely source of pulmonary metastasis in our patient. The prevalence of PLC in pancreatic cancer is not known, but is rare compared with primary cancers of the lung, breast, or stomach (in order of descending frequency).…”

“…The prevalence of PLC in pancreatic cancer is not known, but is rare compared with primary cancers of the lung, breast, or stomach (in order of descending frequency). [15][16][17][18][19] The poor prognosis associated with lymphangitic carcinomatosis is reported in other primary tumor types. 20,21 This has promoted emphasis on early diagnosis of this type of spread, as well as how to best detect and diagnose lymphangitic carcinomatosis more conclusively, by biopsy 21 or a high-resolution CT for patients for whom a biopsy is not feasible.…”