Lung Cancer: Lung Cancer |

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

Fang Wang, MD
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Peking University People's Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A268. doi:10.1016/j.chest.2016.02.280
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SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic gastric cancer, presenting in 6-8% of patients with lung metastases. Here we report a rare case of lymphangitic carcinomatosis as a primary manifestation of gastric adenocarcinoma in a middle-aged woman.

CASE PRESENTATION: A 62-year-old woman presented to the respiratory department with a 6-month history of progressive difficult breathing. She also complained red rash on scalp, hair and weight loss. She went to a local hospital 2 month ago and was examined by CT, which showed diffuse reticular interstitial thickening and multiple small nodules in both lungs (Fig 1a). She received immunosuppressive therapy, yet didn’t respond well. Physical examination found alopecia and red patches on calvarias. Lung auscultation revealed decreased respiratory sounds bilaterally, with dry crackles. Arterial blood gas analysis revealed hypoxemia. CT scan revealed bilateral plural effusion plus a diffuse reticular, nodular and ground-glass pattern (Fig 1b). Serum virology and autoantibody test were negative. Several of serum tumor markers turned out to be elevated. Cytological analysis of BALF showed total cells 0.21×106/mL, macrophagocyte 68%, lymphocyte 28%, segmented cell 4%. Bacterial and fungal BALF cultures were negative, including PCP microscopic and PCR examination. Histopathology of biopsy obtained from cervical skin confirmed to a poorly differentiated, signet ring cell-type adenocarcinoma metastasis (Fig 2a). Gastroscopy revealed two thicken folds with erosive mucosal lesion located on the junction of gastric-antrum and body (Fig 2b). Pathologic analysis of the lesion revealed a signet ring cell-type adenocarcinoma (Fig 2c). On the basis of these findings, poorly differentiated adenocarcinoma of the stomach, with lung lymphangitic carcinomatosis was diagnosed. The patient abandoned further therapy, and died 1 week later.

DISCUSSION: Gastric cancer is one of the most common cancers worldwide. Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic gastric cancer, usually presents with non-specific respiratory complaints. CT scans often have nonspecific appearances such as interstitial thickening, and a nodular pattern. The general prognosis of patients with lymphangitis carcinomatosis is poor. It is important to consider the possibility of lymphangitic carcinomatosis in patients with progressive dyspnea or no other known causes of interstitial lung disease. When there is doubt about the exact diagnosis, a biopsy must be performed.

CONCLUSIONS: It is important to consider the possibility of lymphangitic carcinomatosis in patients with an interstitial pattern on chest radiographs. These patients should be screened for occult neoplasms.

Reference #1: Moubax K, Wuyts W, Vandecaveye V, Prenen H: Pulmonary lymphangitic carcinomatosis as a primary manifestation of gastric carcinoma in a young adult: a case report and review of the literature. BMC Research Notes 2012,5:638

DISCLOSURE: The following authors have nothing to disclose: Fang Wang

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