Pulmonary lymphangitic carcinomatosis as a primary manifestation of gastric carcinoma in a young adult: a case report and review of the literature

Moubax, Kim; Wuyts, Wim; Vandecaveye, Vincent; Prenen, Hans

doi:10.1186/1756-0500-5-638

Cited by 29 publications

(24 citation statements)

References 19 publications

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“…PLC mostly occurs secondary to malignancies of the breast, stomach, lung, prostate, and pancreas [1]. PLC may appear in the natural course of primary disease or may represent the very first finding, as in our case [7]. In nearly 50% of cases, the initial complaints are respiratory symptoms rather than symptoms of an underlying tumor.…”

Section: Discussionmentioning

confidence: 97%

“…Whole-body MRI techniques are reported to be able to accurately identify gastric tumors, as well as liver and skeletal metastases. In addition, they are also suggested as preferable methods in patients with renal dysfunction and contrast allergy [7].…”

Section: Discussionmentioning

confidence: 99%

“…PLC may sometimes appear as the first finding before a diagnosis of tumor [6]. PLC is rarely reported as the first finding related to stomach tumor [7]. A 30-year-old male patient, who was diagnosed with signet cell gastric carcinoma after being admitted with PLC to the clinic and undergoing radiologic examination, is presented owing to his peculiar presentation.…”

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confidence: 99%

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A Rare Case of Progressive Dyspnea and Bilateral Lung Infiltration in a Young Male

et al. 2017

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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. KEYWORDS:Progressive dyspnea, lymphangitic carcinomatosis, gastric cancer INTRODUCTIONPulmonary lymphangitic carcinomatosis (PLC) is the infiltration of pulmonary lymphatic vessels and connective tissue adjacent to these vessels by malignant cells. PLC comprises 6-8% of all lung metastases. The most common underlying tumors found are those of the breast, stomach, lung, prostate, and pancreas. Irrespective of the location of the primary tumor, the prognosis is worse [1].Involvement of the lymphatic vessels usually occurs following hematogenous seeding of the lungs. A less frequent mechanism is retrograde diffusion into the lymphatics of the mediastinal and hilar lymph nodes. Not only the central lymphatics consisting of the bronchovascular interstitium, but also the peripheral lymphatics consisting of the interlobular septa and beneath the pleura are involved. The radiologic features are similar to those of other interstitial lung diseases, which complicates a differential diagnosis. Thickening of bronchovascular bundles and interlobular septa, ground-glass opacity, pleural effusion, mediastinal lymphadenopathy, and nodular lesions are the common radiologic findings [2][3][4][5]. PLC may sometimes appear as the first finding before a diagnosis of tumor [6]. PLC is rarely reported as the first finding related to stomach tumor [7]. A 30-year-old male patient, who was diagnosed with signet cell gastric carcinoma after being admitted with PLC to the clinic and undergoing radiologic examination, is presented owing to his peculiar presentation. CASE PRESENTATIONA 30-year-old male patient presented to our outpatient clinic with complaints of shortness of breath, dry cough, weight loss, and night sweats. His complaints had started 2 months previously with a mild dry cough, which was progressive and had been accompanied by dyspnea during the previous 2 weeks. He had lost 5 kg in weight. His general condition was moderate, he had difficulty talking, and he had an oxygen saturation of 90% on finger probe. On chest X-ray, bilateral reticulonodular infiltration was noted (Figure 1a). He was hospitalized for detailed evaluation and treatment. He did not have any other medical diseases. He had a cigarette smoking history of 5 ...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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A Rare Case of Progressive Dyspnea and Bilateral Lung Infiltration in a Young Male

et al. 2017

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“…Pulmonary lymphangitis carcinomatosis presents spread of tumour cells to the lymphatic system of the lungs. It is known as metastatic infiltration in many neoplastic diseases, like colon, pancreas, lung, breast, renal cancer [3], [4], [5].…”

Section: Discussionmentioning

confidence: 99%

Interstitial lung disease pattern turned out to be a predominantly lepidic lung adenocarcinoma

Hammen¹

2017

Respiratory Medicine Case Reports

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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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“…Furthermore, for reasons that are unclear; there is an increasing trend in incidence in the young population in recent years [7]. Patients with primary gastric cancer and lymphangitic carcinomatosis have a usual presentation of progressive dyspnoea lasting for two to four months before definite diagnosis [8].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Pulmonary Lymphangitic Carcinomatosis in a Young Adult with Carcinoma Stomach

Bhattacharya

Jamil

Khonglah

et al. 2017

JCDR

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A 29-year-old female was admitted with the history of progressive weight loss over the previous three months, difficulty in breathing and minimally productive cough of one week duration. There was no history of fever, haemoptysis, palpitations or chest pain. She gave a history of contact with tuberculosis in her household. She had no history of rash, substance abuse, known allergy or chronic drug intake.On examination she had severe pallor, with hypotension (blood pressure: 96/60 mmHg), tachycardia (pulse rate 138/min) and tachypnoea (respiratory rate: 28/min) with an oxygen saturation of 86% at room air which improved to 92% with supplemental oxygen at 4 L/min. An initial arterial blood gas analysis showed a pO 2 of 67.3 mm Hg, pCO 2 of 28.4 mmHg and a pH of 7.52. There was no cyanosis, pedal oedema, clubbing, lymphadenopathy or ascitis. Respiratory examination revealed bilateral coarse crepitations. Except for tachycardia, cardiac examination was normal. Rest of the systemic examination was normal.Chest x-ray showed bilateral nodular opacities in the mid and lower lung zones [Table/ Fig-1]. Electrocardiography showed sinus tachycardia with right axis deviation. Initial laboratory investigations revealed anaemia with haemoglobin of 6.7gm% and a microcytic hypochromic picture, erythrocyte sedimentation rate of 37 mm/hr, platelet count of 270x10 3 / mm 3 and total leucocyte count of 8400/ mm 3 with 84% neutrophils. The mean corpuscular volume was 69 fl and mean corpuscular haemoglobin was 17 pg/cell. Serum iron was 23 ug/dl and serum ferritin was 67 ng/ml. Her renal and liver function tests, serum electrolytes and coagulogram were within normal limits. Urine analysis was normal and serology for viral markers including HIV, HBV and HCV were non-reactive. Stool routine examination was within normal limits but stool for occult blood came positive.The patient was initially managed to ensure haemodynamic stability with intravenous fluid, transfusion of three units of packed red blood cells, broad spectrum antibiotics along with other symptomatic measures. Sputum analysis for acid fast bacilli was negative and bacteriological culture was sterile. However, based on the history AbSTRACTPulmonary 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-yearold 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 poo...

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Pulmonary lymphangitic carcinomatosis as a primary manifestation of gastric carcinoma in a young adult: a case report and review of the literature

Cited by 29 publications

References 19 publications

A Rare Case of Progressive Dyspnea and Bilateral Lung Infiltration in a Young Male

A Rare Case of Progressive Dyspnea and Bilateral Lung Infiltration in a Young Male

Interstitial lung disease pattern turned out to be a predominantly lepidic lung adenocarcinoma

A Rare Case of Pulmonary Lymphangitic Carcinomatosis in a Young Adult with Carcinoma Stomach

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