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Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma.

Guddati AK, Marak CP - Case Rep Oncol (2012)

Bottom Line: In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs.Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy.This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, St. Vincent's Hospital, Bridgeport, Conn., and New York, N.Y., USA.

ABSTRACT
Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

No MeSH data available.


Related in: MedlinePlus

CXR depicting the interval change between the first and the second admission. a CXR on first admission with no signs of pulmonary involvement. b CXR on second admission depicting reticulo-nodular involvement in all lung fields.
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Figure 2: CXR depicting the interval change between the first and the second admission. a CXR on first admission with no signs of pulmonary involvement. b CXR on second admission depicting reticulo-nodular involvement in all lung fields.

Mentions: He was readmitted two weeks later with right flank pain, dyspnea, fever and cough productive of yellowish sputum. Physical examination was significant for tachycardia, tachypnea, bilateral crepitations in the chest and bilateral 1+ pedal edema. His arterial blood gas showed respiratory alkalosis with an elevated alveolar-arterial (A-a) gradient of 52. His CBC showed leukocytosis at 19,800 cells/μl with 88% neutrophils, hemoglobin of 9.8 g/dl and a platelet count of 588 k/μl. His LFTs were deranged with an albumin of 2.5 g/dl, ALK of 315 and AST/ALT of 166/184. His ESR was elevated at 134 and BUN/creatinine rapidly rose from 13/1 to 24/1.9. Notably, his CXR showed marked infiltration with nodular opacities in all lung fields bilaterally. Fig. 2a shows his CXR during his first admission and fig. 2b shows his CXR at the second admission which reveals marked changes compared to his initial CXR.


Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma.

Guddati AK, Marak CP - Case Rep Oncol (2012)

CXR depicting the interval change between the first and the second admission. a CXR on first admission with no signs of pulmonary involvement. b CXR on second admission depicting reticulo-nodular involvement in all lung fields.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3369259&req=5

Figure 2: CXR depicting the interval change between the first and the second admission. a CXR on first admission with no signs of pulmonary involvement. b CXR on second admission depicting reticulo-nodular involvement in all lung fields.
Mentions: He was readmitted two weeks later with right flank pain, dyspnea, fever and cough productive of yellowish sputum. Physical examination was significant for tachycardia, tachypnea, bilateral crepitations in the chest and bilateral 1+ pedal edema. His arterial blood gas showed respiratory alkalosis with an elevated alveolar-arterial (A-a) gradient of 52. His CBC showed leukocytosis at 19,800 cells/μl with 88% neutrophils, hemoglobin of 9.8 g/dl and a platelet count of 588 k/μl. His LFTs were deranged with an albumin of 2.5 g/dl, ALK of 315 and AST/ALT of 166/184. His ESR was elevated at 134 and BUN/creatinine rapidly rose from 13/1 to 24/1.9. Notably, his CXR showed marked infiltration with nodular opacities in all lung fields bilaterally. Fig. 2a shows his CXR during his first admission and fig. 2b shows his CXR at the second admission which reveals marked changes compared to his initial CXR.

Bottom Line: In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs.Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy.This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, St. Vincent's Hospital, Bridgeport, Conn., and New York, N.Y., USA.

ABSTRACT
Renal cell carcinoma is an aggressive disease with a high rate of mortality. It is known to metastasize to the lung, liver, bone and brain. However, manifestation through lymphatic spread to the lungs is rare. Lymphangitic carcinomatosis is commonly observed in malignancies of the breast, lung, pancreas, colon and cervix. It is unusual to observe lymphangitic carcinomatosis of the lungs due to renal cell carcinoma. Lymphangitic carcinomatosis of the lungs may result in severe respiratory distress and may be the direct cause of death. Currently, there are no known modalities of preventing or slowing lymphangitic carcinomatosis besides treating the primary tumor. However, early detection may change the course of the disease and may prolong survival. This is compounded by the difficulty involved in diagnosing lymphangitic carcinomatosis of the lung which frequently involves lung biopsy. Immunohistochemical studies are often used in conjunction with regular histochemistry in ascertaining the primary tumor and in differentiating it from pulmonary metastasis. In this case report, we describe the presentation and clinical course of renal cell carcinoma in a patient which manifested as lymphangitis carcinomatosa of the lungs. The patient underwent surgical resection of the primary tumor with lymph node resection but presented with a fulminant lymphangitic carcinomatosis of the lungs within two weeks. Immunohistochemistry of the tissue obtained by the biopsy confirmed the diagnosis which was subsequently corroborated during his autopsy. This case illustrates the necessity of an urgent follow-up of chemotherapy and immunotherapy in such patients.

No MeSH data available.


Related in: MedlinePlus