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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

Immunohistochemistry of sample obtained from lung biopsy. a Immunostaining for vimentin. b Immunostaining for CD10. c Immunostaining for CD31.
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Figure 4: Immunohistochemistry of sample obtained from lung biopsy. a Immunostaining for vimentin. b Immunostaining for CD10. c Immunostaining for CD31.

Mentions: He was started on Zosyn and vancomycin and was later switched to aztreonam and clindamycin on account of worsening renal function. His respiratory and blood cultures were negative for any growth. He continued to be febrile, hypoxemic and tachycardic. CT scan to rule out pulmonary embolism could not be performed due to renal failure and Doppler ultrasound of the lower extremities was negative for DVT. CT scan without contrast showed nodular opacities with extensive septal thickening as depicted in fig. 3. An echocardiogram showed a hyperdynamic left ventricle with EF of 80%. The right ventricle size and function were normal. Bronchoscopy with transbronchial biopsy of the right medial lobe was done and biopsy samples revealed non-small cell cancer with clear cell features consistent with renal cell carcinoma and lymphangectatic invasion. Immunohistochemistry showed that the tissue stained positively for vimentin, CD10 and CD 31 as depicted in fig. 4, confirming the renal origin of his tumor. His renal function worsened and he was transferred to the medical ICU where he developed septic shock, he was made DNR and passed away shortly thereafter. The autopsy report showed florid lymphangectatic invasion with focal necrosis, affecting all lobes of both lungs.


Pulmonary Lymphangitic Carcinomatosis due to Renal Cell Carcinoma.

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

Immunohistochemistry of sample obtained from lung biopsy. a Immunostaining for vimentin. b Immunostaining for CD10. c Immunostaining for CD31.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Immunohistochemistry of sample obtained from lung biopsy. a Immunostaining for vimentin. b Immunostaining for CD10. c Immunostaining for CD31.
Mentions: He was started on Zosyn and vancomycin and was later switched to aztreonam and clindamycin on account of worsening renal function. His respiratory and blood cultures were negative for any growth. He continued to be febrile, hypoxemic and tachycardic. CT scan to rule out pulmonary embolism could not be performed due to renal failure and Doppler ultrasound of the lower extremities was negative for DVT. CT scan without contrast showed nodular opacities with extensive septal thickening as depicted in fig. 3. An echocardiogram showed a hyperdynamic left ventricle with EF of 80%. The right ventricle size and function were normal. Bronchoscopy with transbronchial biopsy of the right medial lobe was done and biopsy samples revealed non-small cell cancer with clear cell features consistent with renal cell carcinoma and lymphangectatic invasion. Immunohistochemistry showed that the tissue stained positively for vimentin, CD10 and CD 31 as depicted in fig. 4, confirming the renal origin of his tumor. His renal function worsened and he was transferred to the medical ICU where he developed septic shock, he was made DNR and passed away shortly thereafter. The autopsy report showed florid lymphangectatic invasion with focal necrosis, affecting all lobes of both lungs.

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