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Pulmonary Lymphangitic Carcinomatosis From Colon Adenocarcinoma Without Liver Metastasis FREE TO VIEW

Eric Sandoval, MD; Michael Paikal, MD; David Hsia, MD
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Harbor-UCLA Medical Center, Torrance, CA

Chest. 2013;144(4_MeetingAbstracts):599A. doi:10.1378/chest.1703511
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SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Colon cancer typically metastasizes to the lungs hematogenously after initially involving the liver. Our patient’s case demonstrates simultaneous presentation of two rare pulmonary manifestations of metastatic colon adenocarcinoma.

CASE PRESENTATION: A 39 year-old African American male with a family history of colon cancer initially presented to an outside hospital with 3 months of abdominal pain, hematochezia, and diarrhea. The patient was treated with antibiotics for colitis but his symptoms did not improve. Computerized tomography (CT) scan of the abdomen and pelvis showed thickening of the descending colon wall. Adenocarcinoma of the colon was diagnosed by colonoscopy. He was determined to be stage IIIB (T3N2aM0) after chest CT and Positron Emission Tomography scan were negative for metastasis. Subtotal colectomy with re-anastomosis was performed. He presented 2 weeks later to our hospital with several days of chest pain, dyspnea and fatigue. Physical exam was notable for tachycardia and tachypnea with a normal oxygen saturation. CT showed no evidence of pulmonary embolism, but revealed diffuse perilymphatic thickening and a fine parenchymal nodular pattern. No liver lesions were noted. Flexible bronchoscopy with transbronchial biopsy demonstrated adenocarcinoma. Immunohistochemical studies were consistent with colon adenocarcinoma and he was restaged with stage IV colon cancer. One week later, the patient was readmitted with worsening dyspnea and hypoxia requiring supplemental oxygen. Repeat CT showed interval progression of pulmonary disease with the development of numerous ground glass opacities. He was discharged to hospice care after multi-disciplinary discussion.

DISCUSSION: Pulmonary metastasis usually develops from hematogenous spread of tumor microemboli through pulmonary arteries. Metastases through lymphatics, across the pleural space, and through direct invasion from adjacent structures are less common routes of spread. Pulmonary Lymphangitis Carcinomatosis (PLC) results from diffuse infiltration of the lymphatics of the lungs by malignant cells. PLC is a rare form of malignant metastasis, with the majority of cases originating from breast, stomach, or lung cancers. In addition, metastatic pulmonary manifestations of colon adenocarcinoma rarely occur without concurrent liver involvement.

CONCLUSIONS: PLC and pulmonary metastasis without liver involvement are rare presentations of colon adenocarcinoma.

Reference #1: Bruce D, et al. Lymphangitis carcinomatosa: a literature review. J R Coll Surg Edinb1996;41:7-13

Reference #2: Fraser R, et al. Section VI, Pulmonary neoplasms. In: Fraser and Pare's diagnosis of diseases of the chest. 4th ed. Philadelphia (PA): Elsevier Health Sciences; 1999. p. 1390-7

Reference #3: Thomas A, et al. Pulmonary lymphangetic carcinomatosis as a primary manifestation of colon cancer in a young adult. CMAJ. 2008 August 12; 179(4); 338-340

DISCLOSURE: The following authors have nothing to disclose: Eric Sandoval, Michael Paikal, David Hsia

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