Refers to the diffuse infiltration and obstruction of pulmonary parenchymal lymphatic channels by tumor.
Various neoplasms can cause lymphangitic carcinomatosis (LC), but 80% are adenocarcinomas. The most common primary sites are the breasts, lungs, colon, and stomach.
Other sources include the pancreas, thyroid, cervix, prostate, and larynx. LC can also arise from choriocarcinoma, melanoma, or metastatic adenocarcinoma from an unknown primary cancer.
The usual presenting complaint is breathlessness. Occasionally, patients have a dry cough or hemoptysis. Symptoms often precede the development of any radiographic abnormality.
Although chest radiographs appear normal for 30%–50% of patients with histologically proven disease, pulmonary lymphangitic carcinomatosis has several characteristic changes that can be observed on radiographs:
- bronchovascular markings with irregular outline
- reticulonodular pattern with intraparenchymal extension of tumor
- bilateral changes predominantly in the lower lobes of the lungs
- Kerley A and B lines
- hilar and mediastinal lymphadenopathy
- pleural effusion
In the appropriate clinical circumstances or when the chest radiographic findings are equivocal, the next investigation employs high-resolution computed tomography (HRCT) scanning. Although the appearance of LC on HRCT scans is nonspecific, the observation of certain features in a symptomatic patient with an appropriate history of malignancy is highly suggestive of LC; in such instances, further investigation is generally not required.
Less than half of patients with pulmonary lymphangitic carcinomatosis who present with respiratory symptoms survive for 3 months. Corticosteroids may be effective in the management of dyspnea associated with carcinomatous lymphangitis.
Adapted from Medscape Drugs & Diseases. Lymphangitic carcinomatosis imaging. Available at http://emedicine.medscape.com/article/359006-overview#a1. Accessed on February 15, 2016. To view the entire article and all other content on the Medscape Drugs & Diseases site, a free, one-time registration is required.
Anish T, Lenox R. Pulmonary lymphangitic carcinomatosis as a primary manifestation of colon cancer in a young ad