A rare case of lymphangitis carcinomatosis presenting as diffuse parenchymal lung disease

Abstract

Lymphangitis carcinomatosis (LC) is the infiltration and inflammation of lymphatic vessel secondary to the spread of malignancy from a primary site. Most cases result from dissemination of adenocarcinomas. Its presentation may be unilateral or bilateral, it is asymmetrical and is limited to one lobe of the lung especially lower lobes, focal unilateral presentation is observed in 50% of patients, while only 6%–8% of lung metastases present as diffusely infiltrating pattern. In this case report, we present a case of adenocarcinoma with LC presenting as diffuse parenchymal lung disease which is a rare presentation. A 45-year-old female matchbox industry worker by occupation with no comorbid illness presented with 8-month history of cough with scanty mucoid expectoration and Grade II dyspnea according to the modified Medical Research Council along with history of loss of appetite and weight. CT chest shows parenchymal nodule with spiculated margin in the anterior segment of the upper lobe, nodular thickening of the Broncho vascular interstitium and pleura, diffuse interstitial septal thickening and randomly distributed nodules in all lobes. PET scan showed low grade metabolically active nodule in the anterior segment of the left upper lobe, metabolically active mediastinal, supraclavicular and retrocrural lymph nodes, mild pleural effusion and Low-grade diffuse metabolism was noted in the uterine endometrium. Low-grade diffuse metabolism was noted in the uterine endometrium. Abdominal ultrasound revealed an endometrial thickness of 8 mm. Visual inspection with acetic acid (VIA), visual inspection with lugol's iodine (VILI) and Papanicolaou smear was done which was suggestive of inflammatory smear, and Papanicolaou smear was done and was suggestive of inflammatory smear. Fiber-optic bronchoscopy was done, it was normal, and transbronchial lung biopsy revealed adenocarcinoma lung. The patient was referred to medical oncology, and the first cycle of chemotherapy was started with cisplatin and pemetrexed. Physicians should be aware of pulmonary lymphangitic carcinomatosis from lung adenocarcinoma and consider it in patients with pulmonary symptoms who are unresponsive to antibiotics. Despite establishment of diagnosis with cellular etiology even primary source, the condition is fatal. This rare condition needs to be considered in appropriate clinical settings.

Keywords

• adenocarcinoma
• diffuse parenchymal lung disease
• lymphangitis carcinomatosis