Pulmonary lymphangitic carcinomatosis as a primary manifestation of gastric carcinoma in a young adult: a case report and review of the literature

Abstract

Background: Lymphangitic carcinomatosis as a manifestation of gastric carcinoma is rare. The presenting symptoms are misleading and nonspecific, often resulting in delayed diagnosis.

Case presentation: We present a case of a 24 year old male with progressive dyspnea. Initial radiologic assessment suggested interstitial lung disease, which was subsequently treated with antibiotics and corticosteroids. However, endoscopy and whole body diffusion-weighted magnetic resonance imaging revealed a metastatic gastric cancer with the presence of lymphangitic carcinomatosis.

Conclusions: Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic gastric cancer. Patients present with severe but non-specific respiratory complaints. Definitive diagnosis can be achieved by transbronchial biopsy. Prognosis is poor and optimal treatment is not defined. Whole body diffusion-weighted magnetic resonance imaging is a promising imaging tool for the diagnosis of metastatic gastric cancer.

Figure 1

Chest X-ray at time of first admission shows diffuse diffuse reticulonodular pattern.

Figure 2

(A) High resolution computed tomography of the chest at time of first admission shows bilateral areas of ground-glass opacification and diffusely thickened interlobular septa. Moreover it showed the presence of hilar and mediastinal adenopathies. (B) Repeat scan after broad-spectrum antibiotics and high-dose corticosteroids shows progression of the interstitial disease.

Figure 3

(A,B) WB-DWI with b1000-images and T2-weighted images in the coronal plane shows a tumoral mass in the lesser curvature of the stomach (arrow), (C,D) with diffuse metastases in the lungs and mediastinum as well as skeletal metastases in a right-sided rib and right iliac wing (arrows).

Figure 4

(A,B) WB-DWI with b1000-images and T2-weighted images in the coronal plane shows clear partial regression of the gastric tumour (arrow), (C,D) diffuse metastases in the lungs and mediastinum and skeletal metastases in a right-sided rib and right iliac wing (arrows).