Pulmonary Lymphangitic Carcinomatosis Research Articles

PULMONARY AND SYSTEMIC EOSINOPHILIA-ASSOCIATED WITH METASTATIC COLORECTAL CANCER: A CASE REPORT

SESSION TITLE: Global Case Report Posters SESSION TYPE: Global Case Reports PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Eosinophilia is common in medical practice and can present with variable clinical manifestations. Pulmonary involvement can mimic the clinical presentation of asthma(1-3). Common conditions associated with eosinophilia include allergies, collagen vascular diseases, drugs, parasitic infections, and, rarely, neoplasms(4). Paraneoplastic eosinophilia is a rare presentation in solid cancers(5). Herein, we report a case of a patient with pulmonary eosinophilia as a primary manifestation of metastatic colorectal cancer. CASE PRESENTATION: A 37-year-old female patient presented with a 2-week history of nonproductive cough, wheezing, and progressive dyspnea. She was previously healthy and denied any allergies or significant exposures. Asthma was suspected and treated without improvement. Physical examinations other than hypoxemia and occasional bilateral expiratory wheezing were unremarkable. Chest imaging revealed diffuse bilateral reticulonodular and ground glass opacities with middle and lower lung predominance, Kerley B lines at both lower lungs, bilateral pleural effusion, and enlargement of bilateral hila and paratracheal area. Blood counts reported hypereosinophilia with absolute eosinophil counts of 10,831 cells/μL. Additional tests including stool for parasites and AFB, ANA and anti-dsDNA, and p- and c-ANCA were all negative except for ANA. Bronchoalveolar lavage fluid (BAL) revealed marked eosinophilia of 76%. Tissue pathology from right lower lung and cytology from subcarinal lymph node aspiration revealed poorly differentiated adenocarcinoma with marked eosinophilic infiltration. Pulmonary lymphangitic carcinomatosis was therefore considered. Immunohistochemical staining results reported positive for CK20 and CDX2, but negative for CK7 and TTF-1; this pattern is highly specific for colorectal cancer(6). Due to clinical deterioration, the patient succumbed after two months of her presentation. DISCUSSION: According to our case, initial presentations with dyspnea, wheezing, and cough along with associated hypereosinophilia seemed to be attributed to asthma. However, a worsening course and pulmonary infiltrates prompted an alternative diagnosis, so additional blood tests and tissue pathology were necessary obtained. Pulmonary metastasis and paraneoplastic eosinophilia can rarely be primary manifestations of solid cancers, such as colorectal cancer in this patient. Since pulmonary manifestations of paraneoplastic eosinophilia are nonspecific, a high degree of suspicion and appropriate evaluations can never be overemphasized. CONCLUSIONS: Pulmonary metastasis with paraneoplastic eosinophilia from colorectal cancer may rarely present with asthma-like symptoms but with a more progressive course and presence of pulmonary infiltrates. Tissue diagnosis is required for definitive diagnosis and should be obtained without delay. Reference #1: 1. Rothenburg ME. Eosinophilia. New Engl J Med. 1998;338(22):1592–600. Reference #2: 2. Huss-marp J, Kahn JE, M K, Nutman TB, Pfab F, Ring J, et al. Analysis of Clinical Characteristics and Response To Therapy. J Allergy. 2010;124(6):1–17. Reference #3: 3. Dulohery MM, Patel RR, Schneider F, Ryu JH. Lung involvement in hypereosinophilic syndromes. Respir Med [Internet]. 2011;105(1):114–21. Available from: https://doi.org/10.1016/j.rmed.2010.09.011 DISCLOSURES: No relevant relationships by Santi Silairatana, source=Web Response No relevant relationships by Pitchaya Worapongsatitaya, source=Web Response

Spectrum of 18F-FDG Uptake in Bilateral Lung Parenchymal Diseases on PET/CT.

Bilateral lung parenchymal involvement is seen in infective as well as noninfective conditions, appearing as focal or diffuse lung disease. PET/CT with FDG helps in characterization (increased glucose utilization is seen by both inflammatory and neoplastic cells). In this article, we describe the spectrum of patterns of FDG uptake and associated CT changes involving bilateral lung parenchyma. Benign conditions described are aspiration pneumonia; pulmonary toxicity by bleomycin; infections, namely, sarcoidosis, miliary pulmonary tuberculosis, and pulmonary nocardiosis; and inflammatory conditions such as pulmonary Langerhans cell histiocytosis and pulmonary alveolar proteinosis. Neoplastic conditions described are bilateral pulmonary metastases and lymphangitic carcinomatosis.

Pulmonary Lymphangitic Carcinomatosis: Diagnostic Performance of High-Resolution CT and 18F-FDG PET/CT in Correlation with Clinical Pathologic Outcome.

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.

&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.

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

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

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

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.

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.

The prognostic impact of additional intrathoracic findings in patients with cancer-related pulmonary embolism.

To assess the prevalence and prognostic significance of additional intrathoracic findings (AIFs) in patients with cancer and pulmonary embolism (PE). AIFs were considered alterations other than the characteristic ones intrinsic to PE or changes in cardiovascular morphology. Subjects have been taken from a Spanish national multidisciplinary and multicenter study of PE and cancer who were treated between 2004 and 2015. The endpoint was the appearance of serious complications or death within 15days. The registry contains 1024 eligible patients; 41% diagnosed by computed tomography pulmonary angiography versus 59% by non-angiographic CT. Serious complications occurred within 15days in 18.9%, [95% confidence interval (CI), 16.6-21.4%] and 9.5% (95% CI 7.9-11.5%) died. At least one AIF was seen in 72.6%. The most common AIFs were as follows: pulmonary nodules (30.9%), pleural effusion (30.2%), tumor progression (28.3%), atelectasis (19.0%), pulmonary infarct (15.2%), emphysema (13.4%), pulmonary lymphangitic carcinomatosis (4.5%), and pneumonia (6.1%). Patients with AIF exhibited a higher complication rate at 15days: 21.9% versus 13.0%, odds ratio (OR) 1.8 (95% CI 1.2-2.8), P=0.03, and 15-day mortality: 15.0% versus 7.3%, OR 1.9 (95% CI 1.1-3.2), P=0.020. Patients with pneumonia, pneumothorax, pulmonary edema, pulmonary nodules, tumor progression, pulmonary fibrosis, and pleural effusion showed an excess of adverse events. Additional intrathoracic findings are highly prevalent and significantly impact prognosis in patients with PE and cancer, making them germane to the classification of this population.

Imaging of renal medullary carcinoma in children and young adults: a report from the Children's Oncology Group.

Renal medullary carcinoma is a rare renal malignancy of childhood. There are no large series describing the imaging appearance of renal medullary carcinoma in children. To characterize the clinical and imaging features of pediatric renal medullary carcinoma at initial presentation. We retrospectively analyzed images of 25 pediatric patients with renal medullary carcinoma enrolled in the Children's Oncology Group renal tumors classification, biology and banking study (AREN03B2) from March 2006 to August 2016. Imaging findings of the primary mass, and patterns of locoregional and distant spread were evaluated in correlation with pathological and surgical findings. Median age at presentation was 13years (range: 6-21years), with a male predominance (3.2:1). The overall stage of disease at initial presentation was stage 1 in 1, stage 2 in 2 and stage 4 in 22. Maximum diameter of the primary renal mass ranged from 1.6 to 10.3cm (mean: 6.6cm) with a slight right side predilection (1.5:1). Enlarged (>1cm short axis) retroperitoneal lymph nodes were identified at initial staging in 20/25 (80%) cases, 10 of which were histologically confirmed while the others did not undergo surgical sampling. Enlarged lymph nodes were also identified in the mediastinum (14/25; 56%) and supraclavicular regions (4/25; 16%). Metastatic disease was present in the lungs in 19/25 (76%) and liver in 6/25 (24%). The pattern of lung metastases was pulmonary lymphangitic carcinomatosis: 10 cases (9 bilateral, 1 unilateral), pulmonary nodules with indistinct margins: 6 cases, pulmonary nodules with distinct margins: 2 cases, while 1 case had pulmonary nodules with both indistinct and distinct margins. Pulmonary lymphangitic carcinomatosis was pathologically confirmed in 4/10 cases. All cases with pulmonary lymphangitic carcinomatosis had associated enlarged mediastinal lymph nodes. Renal medullary carcinoma in children and young adults presents at an advanced local and distant stage in the majority of patients. The diagnosis of renal medullary carcinoma should be considered when a child or young adult presents with a poorly defined/infiltrative, centrally located renal mass, especially in the setting of known sickle cell hemoglobinopathy. Distant metastases are common at initial presentation in the lungs, distant lymph nodes and liver and often involve multiple sites simultaneously. Pulmonary lymphangitic carcinomatosis, a distinctive and uncommon form of lung metastasis in children, is common in this patient population.

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

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.

Intralobular septal thickening on chest CT in a patient with pulmonary amyloidosis: a rare case study

A 54-year-old female presented with chronic dry cough and dyspnoea over 3 months and was referred to our outpatient clinic. She had no history of smoking, allergy or respiratory disorders....

Transbronchial cryobiopsy in diffuse parenchymal lung diseases

The diagnostic yield of conventional transbronchial lung biopsy varies among various parenchymal lung diseases: in pulmonary sarcoidosis and lymphangitis carcinomatosa, a diagnosis can be obtained in up to 80% of patients; this method is considered inadequate, however, in identifying more complex histological patterns such as usual interstitial pneumonitis or nonspecific interstitial pneumonitis, mainly because the specimens are tiny and the interpretation is confounded by crush artifacts. Recently, the use of cryoprobes has achieved a significant impact on this issue. This review is about this promising application of cryobiopsy in the diagnostic process of diffuse parenchymal lung diseases. Recent studies document that with transbronchial cryobiopsies, the diagnosis of usual interstitial pneumonitis can be made confidently by pathologists with a good interobserver agreement. Pneumothorax is the main complication (reported in up to one-quarter of cases in some series); bronchial bleeding is usually controlled using Fogarty balloon. Transbronchial cryobiopsy is a promising new technique that may become a valid alternative to surgical lung biopsy in the near feature.

Pulmonary Lymphangitic Carcinomatosis as a Primary Manifestation of Gastric Signet Ring Cell-Type Adenocarcinoma in a Middle-Aged Woman: A Case Report

Pulmonary Lymphangitic Carcinomatosis as a Primary Manifestation of Gastric Signet Ring Cell-Type Adenocarcinoma in a Middle-Aged Woman: A Case Report

Pulmonary Lymphangitic Carcinomatosis due to Metastatic Adenocarcinoma of the Lung: A Case Report

Pulmonary Lymphangitic Carcinomatosis due to Metastatic Adenocarcinoma of the Lung: A Case Report

Pulmonary lymphangitic carcinomatosis from squamous cell carcinoma of the cervix:A retrospective study with review of literature

Background: Pulmonary lymphangitic carcinomatosis (LC) secondary to cervical squamous cell carcinoma (SCC) is an uncommon cause of diffuse infiltrative lung disease. Its reported incidence is quiet low. Materials and Methods: Fifty cases of cervical carcinoma were studied from 2005 to 2014. There was only one case of squamous cell carcinoma cervix that developed pulmonary lymphangitic carcinomatosis subsequently. Clinical manifestations of LC such as dyspnea and non-productive cough can mimic with clinical picture of pneumonia, pneumonitis, pulmonary embolism, congestive heart failure, asthma, and sarcoidosis and thus can be a diagnostic dilemma for treating physician. A review of world literature was also done to examine all the reported cases of cervical carcinoma which presented as pulmonary lymphangitic carcinomatosis. A few cases have been reported so far. Concussion: Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic Squamous Cell Carcinoma (SCC) of the cervix and is associated with a poor prognosis. Increased clinical alertness of such patterns of metastases in cervical cancer along with accurate pathological diagnosis is compulsory to guide proper therapy in these patients.

Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors.

Background. Mistletoe therapy (MT) is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients' general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients' emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.