Lymphangitic Carcinomatosis Research Articles

Computed Tomography Imaging Characteristics of Non–Small-Cell Lung Cancer With Anaplastic Lymphoma Kinase Rearrangements: A Systematic Review and Meta-Analysis

IntroductionSeveral studies have suggested that non–small-cell lung cancer (NSCLC) patients who harbor anaplastic lymphoma kinase (ALK) rearrangement might have different imaging features compared with those without the rearrangement. The goal of this work was to systematically investigate the computed tomography (CT) imaging features of ALK-rearranged NSCLC. Materials and MethodsWe searched published studies that investigated CT imaging features of ALK-rearranged NSCLC compared with ALK-negative, including epidermal growth factor receptor (EGFR)-mutant and ALK/EGFR-negative, NSCLC. We extracted clinicopathologic characteristics and CT imaging features of patients in the included studies. Features were compared and tested in the form of odds ratios (ORs) or weighted mean differences at a 95% confidence interval. ResultsTwelve studies with 2210 patients with NSCLC were included. Compared with ALK-negative NSCLC, ALK-rearranged NSCLC was more likely to be solid (OR, 2.37; P < .001) and less likely to have cavitation (OR, 0.45; P = .002). In advanced stages, patients with ALK-rearranged NSCLC, compared with EGFR-mutant NSCLC, were more likely to have lymphadenopathy (OR, 3.47; P < .001), pericardial metastasis (OR, 2.18; P = .04), pleural metastasis (OR, 2.07; P = .004), and lymphangitic carcinomatosis (OR, 3.41; P = .02), but less likely to have lung metastasis (OR, 0.52; P = .003). Compared with ALK/EGFR-negative NSCLC, ALK-rearranged NSCLC was more likely to have lymphangitic carcinomatosis (OR, 3.88; P = .03), pleural metastasis (OR, 1.89; P = .02), and pleural effusion (OR, 2.94; P = .003). ConclusionALK-rearranged NSCLC has imaging features that are different compared with EGFR-mutant and ALK/EGFR-negative NSCLC. These imaging features might provide clues as to the presence of ALK rearrangement and help in the selection of patients who might benefit from expedited molecular testing or repeat testing after a negative assay.

Lymphangitic carcinomatosis: A common radiographic manifestation of local failure following extended pleurectomy/decortication in patients with malignant pleural mesothelioma

IntroductionThe lymphangitic carcinomatosis (LC) pattern of metastatic malignancy is associated with a poor prognosis but is currently not well defined in malignant pleural mesothelioma (MPM). Here, we report the incidence and prognostic significance of the radiographic development of LC in MPM following extended pleurectomy/decortication (EPD). MethodsConsecutive patients with biopsy-proven MPM undergoing EPD with intraoperative photodynamic therapy (PDT) at our institution from 2008 to 2014 were included in this retrospective study. Patients without available post-surgical clinical or imaging data for direct review were excluded. CT images were reviewed by an experienced, board-certified thoracic radiologist and confirmed by consensus review. Overall survival (OS) and progression-free survival (PFS) were calculated by Kaplan Meier methodology. Hazard ratios were compared with a cox proportional hazard model. Results44 patients underwent EPD with PDT during the study period and had available clinical and imaging data. During the follow-up period (median 34 months), 17 patients (39%) developed LC at a median of 10 months after surgery (IQR 5–21 months). 16 of the 17 patients who developed LC (94%) died during the follow-up period, compared to 17 of the 27 who did not develop LC (63%). OS for the LC versus non-LC group was 53% versus 93% at 1 year and 18% versus 67% at 3 years. LC was significantly associated with a lower OS (HR 4.07; 95% confidence interval 1.44–11.48; p = 0.008). PFS for the LC group versus non-LC group was 8 months (IQR 5–9 months) compared to 17 months (IQR 11–24 months) (p < 0.001). ConclusionLC is a common form of failure in MPM following EPD and is associated with a poor prognosis. Thus, further studies are warranted to determine if any evidence of preoperative LC should be an absolute contraindication to EPD and may warrant an EPP or no surgery at all.

&lt;p&gt;Two cases of lymphangitic carcinomatosis as the primary symptom of colorectal carcinoma that achieved complete remission using combination anti-EGFR antibody therapy&lt;/p&gt;

Clinicians often encounter cases of pulmonary lymphangitic carcinomatosis when treating patients with cancer. When such a condition develops before the diagnosis of cancer, its diagnosis is often challenging. Herein, we report about two patients with colorectal carcinoma diagnosed after the identification of lymphangitic carcinomatosis, which achieved complete remission with combination anti-epidermal growth factor receptor (anti-EGFR) antibody therapy. In case 1, a 74-year-old woman presented with cough and dyspnea that had persisted for 1 month. She had unresectable advanced carcinoma of the sigmoid colon with lymphangitic carcinomatosis. Her respiratory status gradually deteriorated due to the disease. Thus, FOLFIRI plus cetuximab therapy was initiated. Her dyspnea rapidly resolved with the treatment, and complete remission of lymphangitic carcinomatosis was achieved. In case 2, a 46-year-old man presented with fever and dyspnea that had persisted for 1 month. He had unresectable advanced carcinoma of the transverse colon with lymphangitic carcinomatosis. FOLFOXIRI therapy was then initiated. However, his respiratory status did not improve. Therefore, his treatment was immediately switched to FOLFIRI plus panitumumab. His dyspnea rapidly resolved with the treatment, and complete remission of lymphangitic carcinomatosis was achieved. In oncologic emergencies, such as lymphangitic carcinomatosis, requiring an early response to treatment, the administration of anti-EGFR antibodies may be a highly effective treatment option.

Pulmonary lymphangioleiomyomatosis with parietal pleural involvement: A case report and discussion of pathogenesis using pulmonary lymphangitic carcinomatosis as a model

We report a case of sporadic pulmonary lymphangioleiomyomatosis presenting with chylothorax and with parietal pleural involvement by the disease. The implications for the anatomic distribution of lesions in pulmonary lymphangioleiomyomatosis is discussed. The pathogenesis of pulmonary lymphangioleiomyomatosis is reviewed using pulmonary lymphangitic carcinomatosis as a model.

Acute pulmonary hypertension as a symptom of Bard’s syndrome and pulmonary lymphangitis carcinomatosa – rare manifestation of malignant gastric cancer

Introduction. Acute pulmonary hypertension leading to right ventricular failure and circulatory collapse is usually caused by a pulmonary embolism. However, in extremely rare cases, similar clinical manifestations can be related to another diseases, such as lymphangitis carcinomatosa. Aim. The purpose of this paper is to report on the case of a 29-year-old male patient presented with rapidly progressing dyspnoea. Description of the case. The diagnosis of pulmonary embolism was made on the basis of echocardiographic signs of pulmonary hypertension and right ventricular (RV) dilatation, and the recommended therapy was introduced. On the suspicion of bronchopneumonia, antibiotics and steroids were applied. However, the previously stated diagnosis of pulmonary embolism was not confirmed by the angio-CT scan, which showed small diffusive lung parenchyma intra-biliary nodules (ground glass opacity) with the peripheral appearance of a tree-in-bud sign. Consecutive CT of pelvis and abdomen along with endoscopy revealed a metastatic gastric cancer with the presence of lymphangitis carcinomatosa and miliary dissemination to the lungs. The presence of pulmonary metastases in the course of disseminated gastric cancer is known in literature as Bard’s syndrome. Conclusion. Extrapulmonary malignancies, particularly gastric cancer, should be taken into consideration in differential diagnosis in patients with an acute right ventricular failure and nonspecific lesions in the respiratory system.

Preoperative biopsy in periampullary growth can throw surprises!!

Introduction: Periampullary carcinoma are heterogenous group of cancers that comprises of Pancreatic ductal adenocarcinoma, Ampullary adenocarcinoma, Distal Cholangiocarcinoma and Duodenal adenocarcinoma in order of frequency. The surgical management of these tumors are frequently similar due to their shared location. Reported incidence of Benign diseases after pancreatico duodenectomy is as high as 13% . Biopsy is not required in operable cases of periampullary growth. We studied our center biopsy reports in periampullary and Incidence of benign disease of pancreaticoduodenectomy patients. Method: We collected retrospective data for January 2016 to Febrary 2019 of patients diagnosed with Periampullary cancer from our hospital registry. We have included biopsy report of patients who have underwent surgery and palliative chemotherapy. We studied significance of biopsy in diagnosing the disease and incidence of benign diseases in pancreaticoduodenectomy specimen. Result: A total of 185 patients treated for periampullary carcinoma of which biopsy done in 124 patients. Overall Sensitivity in biopsy of periampullary growth is 72% . Interestingly two biopsies reported Lymphangitis carcinomatosa and one reported lymphoma. PET CT of lymphangitis carcinomatosa patient showed lung and liver metastasis which was not seen in contrast CT. A total of 64 patients underwent Pancreatico duodenectomy of which benign diseases were reported in 6 patients- 2 autoimmune pancreatitis, 2 chronic pancreatitis, one ampullary adenoma and one tuberculosis. Conclusion: Pancreaticoduodenectomy though the mortality is less than 2% Morbidity still remains high (30-50%). Though the sensitivity of Biopsy is low its specificity is high and with modern techniques in biopsy, microscopy examination and Immunohistochemistry the sensitivity is likely to improve. Hence would like to consider biopsy of periampullary growth whenever feasible as biopsy can still throw surprises avoiding non productive surgery like pancreaticoduodenectomy.

Primer Akciğer Kanserlerinde Lenfanjitis Karsinomatozanın Evre ve Sağkalım Üzerine Etkisi

Primer Akciğer Kanserlerinde Lenfanjitis Karsinomatozanın Evre ve Sağkalım Üzerine Etkisi

Incidental finding of pulmonary lymphangitis carcinomatosa in a patient of chest trauma

Incidental finding of pulmonary lymphangitis carcinomatosa in a patient of chest trauma

Sudden Unexpected Death During Bronchoscopy of a Patient with Pulmonary Lymphangitic Carcinomatosis and Pulmonary Tumor Thrombotic Microangiopathy due to Gastric Cancer

Sudden Unexpected Death During Bronchoscopy of a Patient with Pulmonary Lymphangitic Carcinomatosis and Pulmonary Tumor Thrombotic Microangiopathy due to Gastric Cancer

Relationship between EGFR mutation and computed tomography characteristics of the lung in patients with lung adenocarcinoma.

BackgroundThe aim of this study was to investigate the relationship between EGFR mutation and computed tomography (CT) features in patients with adenocarcinoma of the lung.MethodsOne hundred and ninety two lung adenocarcinoma patients who underwent surgery were retrospectively included in this study. Examination of EGFR gene mutation was performed on all resected tumor samples. The 192 recruited lung adenocarcinoma patients were divided into groups according to EGFR mutation status: patients with mutations in exons 18–21 (effective mutated, n = 61) and non‐mutated (n = 131). The clinical characteristics and lung CT imaging features of the two groups were recorded and compared. Univariate and logistic regression analysis were performed to identify the independent risk factors relevant to effective EGFR gene mutation.ResultsThe independent risk factors relevant to effective EGFR mutation were evaluated by logistic regression test. The results indicated that female gender (odds ratio [OR] 3.23), lung CT features of lymphangitis carcinomatosa (OR 2.66), semi‐solid lesion density (OR 3.56), and spicule sign (OR 1.61) were independent risk factors relevant to EGFR mutation.ConclusionFemale patients with lung CT features of lymphangitis carcinomatosa, semi‐solid lesion density, and spicule sign are more prone to harbor EGFR gene mutations and are more likely to benefit from targeted therapy.

Acute kidney injury associated with lymphangitic carcinomatosis.

Acute kidney injury (AKI) is a major complication in patients with cancer, associated with significant morbidity and mortality. Only two cases of kidney lymphangitic carcinomatosis associated with AKI have been reported, in gastric and colorectal adenocarcinoma. Here, we report on a 53-year-old man with pancreatic adenocarcinoma who developed AKI as a result of kidney lymphangitic carcinomatosis. The patient rapidly became anuric and required haemodialysis. Kidney lymphangitic carcinomatosis should be considered as a cause of AKI in patients with cancer and may become a more frequent clinical finding as patients with metastatic carcinoma survive for longer.

P46 Experience in the Treatment of 13 Cases of Pulmonary Lymphangitic Carcinomatosis with Apatinib

P46 Experience in the Treatment of 13 Cases of Pulmonary Lymphangitic Carcinomatosis with Apatinib

Successfully treatment by eribulin in visceral crisis: a case of lymphangitic carcinomatosis from metastatic breast cancer

BackgroundMetastatic breast cancer (MBC) rest an incurably disease associated with bad prognosis and a median overall survival of 23–31 months. There are several treatment options including chemotherapy and sometimes endocrine therapy. Currently, there is no standard treatment for patients with MBC who have already benefited from anthracyclines and taxanes therapy. Many drugs like capecitabine, eribulin, gemcitabine, vinorelbin and liposomal doxorubicin are conventionally used as monotherapy. One important complication from MBC is life threating visceral crisis that needs a fast-effective treatment.Case presentationWe report here a case of an evolution of metastatic breast cancer with lymphangitic carcinomatosis after taxane based chemotherapy and endocrine therapy. This 37-year-old woman was referred to our hospital with complaints of dyspnea and dry cough. There was clinical concern for visceral crisis and a chemotherapy with eribulin was initiated. Pulmonary lymphangitic carcinomatosis disappeared and the patient achieved a good partial response.ConclusionWe reported a case of rapid, positive treatment response using eribulin on metastatic breast cancer with visceral crisis and we could quoted others. Therefore, eribulin may be an appropriate chemotherapeutic option in instances requiring rapid symptom control.

Cutaneous lymphangitic carcinomatosis associated with parotid gland duct carcinoma: An unreported case

Cutaneous lymphangitic carcinomatosis associated with parotid gland duct carcinoma: An unreported case

Lung Adenocarcinoma with Gingival Metastasis.

Gingival metastasis of lung cancer is uncommon. We report the case of an 82-year-old male smoker admitted to the pulmonology department with right pleural effusion. A chest computed tomography (CT) scan showed an invasive right hilar tumour, adherent to the superior vena cava, pulmonary artery, main right bronchus, mediastinal pleura and pericardium with lymphangitic carcinomatosis of the right lung. Pleural biopsy revealed pleural metastasis of pulmonary adenocarcinoma, its primary lung origin being confirmed by immunohistochemistry. One month later, the patient developed an ulcerated polypoid gingival mass. Biopsy of this lesion showed a poorly differentiated carcinoma compatible with metastasis from the lung adenocarcinoma. The patient underwent irradiation of the gingival mass at a dose of 30 Gray, but his condition worsened rapidly and he was not fit for chemotherapy. He received palliative treatment and died 2 months after diagnosis of his metastatic lung cancer.LEARNING POINTSLung cancers mostly metastasize to the bones, liver, lymph nodes, brain, lung and adrenal glands, with adenocarcinoma being the most common histological type.Distant metastasis to the oral region is very uncommon but can be the first manifestation of a primary tumour.Oral metastasis can be mistaken for a benign lesion, so a biopsy should be taken for further analysis.

Acantholytic squamous cell carcinoma of the lung with marked lymphogenous metastases and high titers of myeloperoxidase-antineutrophil cytoplasmic antibodies: a case report

BackgroundAcantholytic squamous cell carcinoma (ASQCC), histologically characterized by intercellular bridge loosening, is recognized as a rare variant of squamous cell carcinoma (SQCC). ASQCC may demonstrate a worse prognosis than conventional SQCC. Pulmonary ASQCC is particularly rare; its biological behavior and prognostic data have not been reported.Case presentationWe report the clinical and autopsy findings of a 71-year-old Japanese man with pulmonary ASQCC. Pulmonary lesions, suggestive of idiopathic interstitial pneumonia, were radiologically observed 3 and 6 years prior to the patient’s most recent hospitalization; however, the patient did not undergo further medical examinations. Upon being discovered unconscious, the patient was admitted to our hospital. Dehydration and lower limb muscle weakness were noted, as were laboratory findings of coagulation abnormalities and renal dysfunction. Computed tomography helped confirm a 21-mm peripheral nodule in the upper left lobe of the lung, with associated swollen lymph nodes in the bilateral hilar, mediastinal, and para-aortic regions. Brain and spinal lesions, suggestive of neurological disturbances, were not found. Small cell lung carcinoma was suspected, upon admission, but high serum levels of squamous cell carcinoma antigen and cytokeratin-19 fragments were present. Therefore, advanced lung cancer, possibly SQCC, was diagnosed. The patient was treated with best supportive therapy, and died one month after admission. Hypercalcemia and high serum levels of parathyroid hormone-related protein (PTHrP) and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers were observed. Progressive renal insufficiency was absent due to improved renal function subsequent to hydration. An autopsy helped confirm the left lung tumor as an ASQCC associated with pulmonary lymphangitic carcinomatosis and multiple metastases in the lungs and lymph nodes. Skin lesions suggesting malignant tumors were absent. The metastatic lesions consisted largely of acantholytic tumor cells, and the lungs showed usual interstitial pneumonia pattern; vasculitis was absent.ConclusionsThis is the first reported case of pulmonary ASQCC resulting in an aggressive clinical course, with marked lymphogenous metastases and PTHrP-associated hypercalcemia. The high serum MPO-ANCA titers were clinicopathologically insignificant, but may have been related to the pulmonary interstitial lesion. Pulmonary ASQCC represents a highly malignant subset of lung cancer.

Lymphangitis carcinomatosa of a cutaneous squamous cell carcinoma

An 83-year-old woman presented with erythema, papules and nodules on the left upper arm (figure 1A). She was treated with antibiotics by her general practitioner, with no disease response. Eight...

Lung Adenocarcinoma with Lymphangitic Carcinomatosis Showing Rapid Response to Anti-PD-1 Immunotherapy: A Brief Report

Lymphangitic carcinomatosis is a difficult to treat disease entity and usually portends a poor prognosis given the advanced state in which it is often diagnosed. Treatment is usually based on standard therapy of the primary malignancy, but in most cases, is palliative in nature. This case highlights the potential for PD-1 immunotherapy as both a rapid and durable treatment for lymphangitic carcinomatosis.

Thoracic manifestations of Gynecological tumors: Airway and lung parenchymal involvement commoner in endometrial and ovarian cancers while pleural and interstitial involvement is predominant in cervix malignancies

Introduction:The thorax is a frequent site of metastasis from numerous non-pulmonary cancers. Intrathoracic metastatic disease may manifest in a variety of forms, including solitary or multiple pulmonary nodules, endobronchial tumor, lymphangitic carcinomatosis, or a pleural effusion.Material and Methods:This is muticentric, observational study conducted in Pulmonary Medicine, MIMSR medical college & Venkatesh chest hospital and critical care center, Latur during June 2012 to November 2016 to observe various thoracic manifestations of gynecological malignancies. Total 2300 cases of various gynecological malignancies were screened and finally 330 cases showing various thoracic manifestations were enrolled after subjecting those cases to inclusion and exclusion criteria. All study cases were subjected to chest radiological investigations and histopathological investigations whenever necessary to diagnose metastatic disease. Hospital’s ethical committee & IRB approval has been taken and written informed consent of patient was taken before enrollment.Results:Screened total 2000 cases of gynecological malignancies (ovary, endometrium, cervix & benign ovarian tumors) and selected 330 cases with various metastatic thoracic manifestations. Malignant gynecological tumors including endometrial, cervical & ovarian cancers predominantly observed in above 50 years of age while benign ovarian and uterine tumors in below 50 years of age (p<0.00001). In study of 100 cases of ovarian cancer with thoracic manifestation, documented lung mass lesion as predominant involvement in 38% cases, pleural effusion in 19% cases & lymphangitic carcinomatosis in 11 % cases. In study of 100 cases of endometrial cancer with thoracic manifestation, documented lung mass lesion as predominant in 58% cases, endobronchial metastasis in 16% cases & lymphangitic carcinomatosis in 6 % cases. In study of 100 cases of cervical cancer with thoracic manifestation, documented lymphangitic carcinomatosis as predominant in 36 % cases, pleural effusion in 26% cases & endobronchial metastasis in 5 % cases. Lung metastasis and endobronchial involvement documented predominantly in ovarian and endometrial malignancies while pleural effusion and lymphangitic carcinomatosis documented predominantly in cervical malignancies (p<0.00001). Involvement of airway (endobronchial metastasis) and lung parenchymal mass lesion predominantly documented in endometrial malignancies; lung parenchymal (mass lesion) with lymphangitic carcinomatosis in ovarian malignancies and predominantly pleural involvement with lymphangitic carcinomatosis documented in cervical malignancies (p<0.003).Conclusions:Thoracic metastatic manifestations of gynecological tumors are underdiagnosed & less reported in clinical practice because of lack of suspicion & use of modern radiological techniques to diagnose these lesions. Cases with gynecological tumors with respiratory symptoms should be evaluated with all possible conventional & advanced diagnostic methods to document metastatic manifestations of these tumors to have successful treatment outcome and longevity in survival.

Lymphangitic Carcinomatosis From Prostate Cancer Identified With Gallium-68 Prostate-specific Membrane Antigen Positron Emission Tomography Imaging

Lymphangitic carcinomatosis refers to the rare process of diffuse malignant invasion of the pulmonary lymphatics. We describe the first reported case of lymphangitic carcinomatosis visualized with gallium-68 prostate-specific membrane antigen positron emission tomography and its clinical significance in a 53-year-old man with prostate carcinoma. This case highlights the ability of gallium-68 prostate-specific membrane antigen positron emission tomography for prostate carcinoma characterization and the importance of always considering atypical patterns of metastatic disease.