Pulmonary lymphangitic carcinomatosis from squamous cell carcinoma of the cervix

Abstract

Introduction: Pulmonary metastasis presenting as lymphangitic carcinomatosis arising from squamous cell carcinoma (SCC) of the cervix is a rare event. Poorly represented in the literature, this event is associated with a) difficulty in accurate diagnosis, b) grave prognosis, and the c) lack of recognized predisposing risk factors.

Case report: A 50 year-old female presented at our practice with a three-month history of a productive cough associated with dyspnoea and shortness of breath. A chest x-ray and computed tomography (CT) scan revealed multiple bilateral patchy areas with subsegmental atelectasis in both lungs which was investigated with a bronchoscopy, left thoracoscopy, and a left lung biopsy. Pathological examination of the wedge biopsy of the left upper lobe revealed neoplastic sheets of cell disturbed along the septal vessels, perivascular/peribronchial lymphatics, and the subpleural lymphatics. This lymphangitic carcinomatosis was confirmed to be metastatic from SCC of the cervix that had been diagnosed and treated two years ago. She was treated with systemic Carbo/Taxol chemotherapy and corticosteroids as a palliative measure. Despite temporary improvement, she died 13 months later.

Conclusion: Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic SCC of the cervix. As clinical presentations including radiographic imaging mimics other pulmonary entities, accurate diagnosis remains a challenge. Increased clinical awareness of such patterns of metastases in cervical cancer supported by accurate pathological diagnosis is imperative to guide appropriate therapy in these patients.

Figure 1

Histopathology-Lung Biopsy:Haematoxylin and Eosin stained slides [1A,1B and 1C]; Immunohistochemical stained slides [1D, 1E and 1F]. 1A, 1B, 1C: Hemotoxylin-eosin stain slides at medium power (magnification ×250) demonstrates the neoplastic cells in a perivascular peribronchial lymphatics (1A, black arrow head), along the septal vessels (1B, black arrow head), and subpleural lymphatics (1C, black arrow). 1D, 1E, 1F: Immunohistochemicals stain at medium power (magnification ×250): p16 shows strong positive nuclear and cytoplasmic staining of the peribronchial lymphatics (1D, black arrow head); high molecular weight keratin shows strong positive membranous staining of the lesional cells (1E, black arrow); cytokerain 7 (CK7) demonstrates the strong positive staining of the lesional cells in the subpleural lymphatics (1F, black arrow).