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Case No : 138 Date 2000-06-17
- Courtesy of Yookyung Kim, M.D. / Eulji College Hospital, Taejon, Korea
- Age/Sex 41 / F
- Chief ComplaintProgressive dyspnea for one month and palpable supraclavicular mass
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Hematolymphangitic Metastasis in a colon cancer patient
- Radiologic Findings
- Chest radiograph shows diffuse reticulonodular opacities in association with several large nodules in both lungs. Right paratracheal widening is observed.
Mediastinal window setting images of high-resolution CT scan show multiple enlarged mediastinal lymph nodes. Punctate or amorphous calcifications are identified in the enlarged lymph nodes.
Lung window setting images of HRCT scan shows nodular thickenings of interlobular septa, peribronchovascular interstitium and interlobar fissures in both lungs. There are several nodules in RML & lingular segment, showing pseudocavitations (bubblelike areas of low attenuation). - Brief Review
- Pulmonary lymphangitic carcinomatosis (PLC) occurs commonly in patients with metastatic adenocarcinomas from the breast, lung, stomach, colon, pancreas, or cervix. PLC usually results from hematogenous spread to lung, with subsequent interstitial and lymphatic invasion, but can also occur because of direct lymphatic spread of tumor from mediastinal and hilar lymph nodes. Tumor growth in the lymphatics in peribronchovascular interstitium, interlobular septa and subpleural regions, and associated edema, result in characteristic HRCT findings of smooth or nodular interstitial thickenings with preservation of normal lung architecture. Diseases showing smooth (pulmonary edema) or nodular interstitial thickenings (sarcoidosis or silicosis) should be included in differential diagnosis.
Calcified mediastinal or hilar lymph nodes are most frequently identified in patients with granulomatous disease such as tuberculosis or histoplasmosis. In this entity, lymph nodes are usually diffusely calcified. Calcified lymph nodes may also be seen in patients with sarcoidosis, silicosis or coal worker's pneumoconiosis, Hodgkin's disease following preceding radiation, amyloidosis, scleroderma, Castleman's disease and in AIDS patients with pneumocystis carinii infection. Rarely, calcification may occur within nodes as a result of metastatic disease, typically from the colon.
Pseudocavitation (bubblelike areas of low attenuation within a nodule) is one of characteristic findings of nodular form of bronchioloalveolar carcinoma (BAC), a subtype of adenocarcinoma. Diagnosis of BAC can be made in patients who do not have other bronchogenic adenocarcinoma nor adenocarcinoma involving another organ, because metastatic adenocarcinoma from colon, pancreas, or biliary tract with growth along the alveolar septa may mimic BAC histologically. Metastatic adenocarcinoma may also shows radiologic findings similar to bronchioloalveolar carcinoma. - References
- 1. Munk PL, Muller NL, Miller RR, Ostrow DN. Pulmonary lymphangitic carcinomatosis: CT and pathologic findings. Radiology 1988; 166:705-709
.2. Mediastinum. In Naidich DP, Zerhouni EA, Siegelman SS. Computed tomography and magnetic resonance of the thorax. 2nd ed. New York: Raven Press, 1991:35-148
3. Lee KS, Kim Y, Han J, Ko, EJ, Park CK, Primack SL. Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. Radiographics 1997;17:1345-1357 - Keywords
- Lung, Malignant tumor,
No. of Applicants : 65
- ▶ Correct Answer : 53/65, 81.5%
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- - 媛 理
- - 嫄곗갹
- - 嫄닿뎅
- - 寃쏀щ
- - 怨
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- - 留 臾멸린
- - 蹂대蹂 源
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- - 遺 二쇱
- - 源
- - 諛李쎈
- - 臾몄밴
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- - 源
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- - 瑜
- - 源
- - 蹂以
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- - 怨쏀⑥
- - 議곗 源以
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- - 沅諛곗＜
- - Baptist Hosp., Pusan, Korea Mi-Jeong Shin
- - Dong-A University Hospital Ki-Nam Lee
- - Gachon Medical School Gil Medical Center Seo Joon Beom
- - Hospital General Universitario de Alicante, Spain Juan Arenas
- - Matsuyama Red Cross Hospital,Matsuyama,Japan Shunya Sunami
- - Samsung Medical Center Kyung Soo Lee
- - Seoul National University Hospital Seong Ho Park
- - Seoul National University Hospital Choi Hyuck Jae
- - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- - Hospital de Guipuzcoa / San Sebastian / Spain Gonzalo Vega - Hazas Porrua
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