Lymphangitis carcinomatosa: Difference between revisions

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*The [[pathogenesis]] of [[lymphangitis]] carcinomatosa is characterized by the [[tumoral]] [[Spread of the cancer|spread]] into the [[lymphatics]], following hematogenous seeding of the [[lungs]].  <ref name="BiswasSriram2015">{{cite journal|last1=Biswas|first1=Abhishek|last2=Sriram|first2=Peruvemba S.|title=Getting the Whole Picture: Lymphangitic Carcinomatosis|journal=The American Journal of Medicine|volume=128|issue=8|year=2015|pages=837–840|issn=00029343|doi=10.1016/j.amjmed.2015.04.007}}</ref>
*The [[pathogenesis]] of [[lymphangitis]] carcinomatosa is characterized by the [[tumoral]] [[Spread of the cancer|spread]] into the [[lymphatics]], following hematogenous seeding of the [[lungs]].  <ref name="BiswasSriram2015">{{cite journal|last1=Biswas|first1=Abhishek|last2=Sriram|first2=Peruvemba S.|title=Getting the Whole Picture: Lymphangitic Carcinomatosis|journal=The American Journal of Medicine|volume=128|issue=8|year=2015|pages=837–840|issn=00029343|doi=10.1016/j.amjmed.2015.04.007}}</ref>
*The [[pathogenesis]] is also characterized by retrograde [[Spread of the cancer|spread]] into [[lymphatics]] from the [[mediastinal]] and [[hilar]] [[lymph nodes]] in the [[lungs]].  
*The [[pathogenesis]] is also characterized by retrograde [[Spread of the cancer|spread]] into [[lymphatics]] from the [[mediastinal]] and [[hilar]] [[lymph nodes]] in the [[lungs]].  
*Both the peripheral lymphatics coursing in the interlobular septa and beneath the pleura, and the central lymphatics coursing in the bronchovascular interstitium are involved.  
*Both the peripheral lymphatics coursing in the interlobular [[septa]] and beneath the [[pleura]], and the central [[lymphatics]] coursing in the bronchovascular [[interstitium]] are involved.  
*There are no specific [[genetic]] [[mutations]] associated with the [[development]] of [[lymphangitis]] carcinomatosa.  
*There are no specific [[genetic]] [[mutations]] associated with the [[development]] of [[lymphangitis]] carcinomatosa.  
*On [[gross pathology]], characteristic findings of [[lymphangitis]] carcinomatosa include:<ref name="lymph">Lymphangitis carcinomatosa. Libre Pathology. https://librepathology.org/wiki/Pulmonary_lymphangitic_carcinomatosis</ref>
*On [[gross pathology]], characteristic findings of [[lymphangitis]] carcinomatosa include:<ref name="lymph">Lymphangitis carcinomatosa. Libre Pathology. https://librepathology.org/wiki/Pulmonary_lymphangitic_carcinomatosis</ref>
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*[[Lymphangitis]] carcinomatosa must be [[Differentiate|differentiated]] from other [[diseases]] that cause thickened [[interlobular]] [[septa]]e (on imaging finding), [[dyspnea]], [[fatigue]], and [[weight-loss]], such as:
*[[Lymphangitis]] carcinomatosa must be [[Differentiate|differentiated]] from other [[diseases]] that cause thickened [[interlobular]] [[septa]]e (on imaging finding), [[dyspnea]], [[fatigue]], and [[weight-loss]], such as:
:*[[Sarcoidosis]]
:*[[Sarcoidosis]]
:*Pulmonary Alveolar Proteinosis
:*[[Pulmonary]] [[Alveolar]] [[Protein|Proteinosis]]
:*[[Viral pneumonia]]; pneumocystis jirovecii
:*[[Viral pneumonia]]; [[pneumocystis jirovecii]]
:*[[Pulmonary edema]]
:*[[Pulmonary edema]]
:*[[Pneumonitis|Radiation pneumonitis]]
:*[[Pneumonitis|Radiation pneumonitis]]
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===Gender===
===Gender===
*The condition affects males more than the females
*The condition affects [[males]] more than the [[Female|females]]
*Affects a younger population than that affected with most malignancies
*Affects a younger [[population]] than that affected with most [[malignancies]]


===Race===
===Race===
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:*[[Pulmonary hypertension]]  
:*[[Pulmonary hypertension]]  
*[[Prognosis]] is generally poor, and the [[mean]] [[survival rate]] of [[patients]] after [[diagnosis]] of [[lymphangitis]] carcinomatosa is approximately 6 months.
*[[Prognosis]] is generally poor, and the [[mean]] [[survival rate]] of [[patients]] after [[diagnosis]] of [[lymphangitis]] carcinomatosa is approximately 6 months.
*Approximately half of [[patients]] succumbing to their [[illness]] within a year of [[diagnosis]].  
*Approximately half of [[patients]] succumbing to their [[illness]] within a [[year]] of [[diagnosis]].  
*Occasionally, long-term [[Survival rate|survival]] is encountered.
*Occasionally, long-term [[Survival rate|survival]] is encountered.



Revision as of 13:34, 3 June 2019

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List of terms related to Lymphangitis carcinomatosa

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Swathi Venkatesan, M.B.B.S.[2]

Synonyms and keywords: Lymphangitis carcinomatosis; Pulmonary lymphangitic carcinomatosis

Overview

Lymphangitis carcinomatosa also known as carcinomatous lymphangitis, is an inflammation of the lymph vessels secondary to a malignancy. Lymphangitis carcinomatosa was first discovered by Gabriel Andral, a French pathologist, in 1829. The pathogenesis of lymphangitis carcinomatosa is characterized by the tumoral spread into the lymphatics, following hematogenous seeding of the lungs. The pathogenesis is also characterized by retrograde spread into lymphatics from the mediastinal and hilar lymph nodes in the lungs. Common causes of lymphangitis carcinomatosa include breast cancer (most common), lung cancer, colon cancer, stomach cancer, prostate cancer, cervical cancer, and thyroid cancer. Lymphangitis carcinomatosa is a rare disease. The prevalence of lymphangitis carcinomatosa is approximately 0.03 per 100,000 individuals worldwide. Lymphangitis carcinomatosa is more commonly observed among patients aged between 40 to 49 years old. Computed tomography is the imaging modality of choice for lymphangitis carcinomatosa. On CT, characteristic findings of lymphangitis carcinomatosa include subpleural nodules, thickening on the interlobar fissures, pleural effusion, and hilar and mediastinal nodal enlargement (40-50%). The mainstay therapy for lymphangitis carcinomatosa is systemic chemotherapy (chemotherapeutic regimen depends on the tumor histology).

Historical Perspective

Classification

Pathophysiology

  • No remarkable findings
Poorly differentiated adenocarcinoma within lymphatics surrounding an artery. Yale Rosen from USA [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)],https://upload.wikimedia.org/wikipedia/commons/3/34/Metastatic_gastric_adenocarcinoma-lymphangitic_carcinomatosis_%287261944992%29.jpg,https://commons.wikimedia.org/wiki/File:Metastatic_gastric_adenocarcinoma-lymphangitic_carcinomatosis_(7261944992).jpg

Causes

Differentiating Lymphangitis Carcinomatosa from Other Diseases

Epidemiology and Demographics

Age

Gender

Race

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Auscultation

Percussion

Laboratory Findings

  • There are no specific laboratory findings associated with lymphangitis carcinomatosa.[6]
  • Even if histologically confirmed, the chest radiograph is normal in 30–50% of cases.

Imaging Findings

Left breast mass, mediastinal lymphadenopathy and features of lymphangitis carcinomatosis. In addition scattered bony metastatic lesions are seen in dorsal vertebrae, Case courtesy of Dr Paresh K Desai , Radiopaedia.org, rID: 17917, Case courtesy of Dr Paresh K Desai , <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/17917">rID: 17917</a>

Treatment

Medical Therapy

Surgery

Prevention

References

  1. Doyle, L (2018). "Gabriel Andral (1797-1876) and the First Reports of Lymphangitis Carcinomatosa". Journal of the Royal Society of Medicine. 82 (8): 491–493. doi:10.1177/014107688908200814. ISSN 0141-0768.
  2. 2.0 2.1 Biswas, Abhishek; Sriram, Peruvemba S. (2015). "Getting the Whole Picture: Lymphangitic Carcinomatosis". The American Journal of Medicine. 128 (8): 837–840. doi:10.1016/j.amjmed.2015.04.007. ISSN 0002-9343.
  3. 3.0 3.1 3.2 Lymphangitis carcinomatosa. Libre Pathology. https://librepathology.org/wiki/Pulmonary_lymphangitic_carcinomatosis
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Lymphangitis carcinomatosa. Radiopedia. http://radiopaedia.org/articles/lymphangitic-carcinomatosis
  5. Khachekian, Arsineh; Shargh, Sean; Arabian, Sarkis (2015). "Pulmonary Lymphangitic Carcinomatosis From Metastatic Gastric Adenocarcinoma: Case Report". The Journal of the American Osteopathic Association. 115 (5): 332. doi:10.7556/jaoa.2015.064. ISSN 0098-6151.
  6. Gilchrist, F. J.; Alton, H.; Brundler, M.-A.; Edwards, L.; Plunkett, A.; Rao, S. (2011). "Pulmonary lymphangitic carcinomatosis presenting as severe interstitial lung disease in a 15-year-old female". European Respiratory Review. 20 (121): 208–210. doi:10.1183/09059180.00000911. ISSN 0905-9180.