Pulmonary Lymphangitic Carcinomatosis from Rectal Cancer: Report of a Case

Abstract

Pulmonary lymphangitic carcinomatosis (LC) is defined as the presence of tumor cells in the pulmonary lymphatic vessels and lung interstitium. Pulmonary LC is a rare form of lung metastasis from rectal cancer. Here, we report the case of a 57- year-old woman who developed dyspnea after neoadjuvant concurrent chemoradiation therapy (CCRT) for rectal cancer. Chest radiographs revealed bilateral reticulonodular infiltrates and pleural effusion but no obvious nodules. The patient was treated as a case of pneumonia initially but the dyspnea worsened rapidly. For lack of bacterial growth from sputum culture, and on account of the cytological examination of the pleural effusion which revealed malignant cells. pulmonary LC was suspected and systemic chemotherapy was prescribed; however, the treatment was ineffective and the patient died of acute progressive respiratory failure. We suggest if a patient having cancer presents with respiratory compromise and increased bilateral infiltration and/or reticulonodular changes on chest radiographs, the possibility of pulmonary LC should be considered. If the patient treated as a case of pneumonia or other benign diseases, has a rapidly worsening clinical course, early diagnosis and aggressive chemotherapy are essential for the proper management of pulmonary LC.