Pulmonary Lymphangitic Carcinomatosis from Rectal Cancer: Report of a Case

肺部淋巴管炎癌細胞轉移是一種少見的癌症肺部轉移形式，與一般肺部轉移以結節或腫塊表現不同，特點在肺部淋巴管內有散布性浸潤癌細胞，胸部X光攝影典型表現是兩側網狀結節浸潤或肋膜積水，病人表現爲進展性咳嗽及呼吸困難，通常病程進展很快且預後很差。我們報告一位57歲女性直腸癌病人在完成術前新輔助化學放射治療後，在等待手術期間突然發生呼吸急促及發燒現象而入院治療，起初因爲胸部X光有雙側肺部浸潤現象，所以初步診斷爲肺部感染給予抗生素治療，但是病況很快惡化，肋膜積水抽吸細胞學檢查結果有癌細胞，懷疑爲肺部淋巴管炎癌細胞轉移，之後接受第二線化學治療，但是病程持續進展，病人在接受化學治療後第三天因急性呼吸衰竭死亡。本論文提出此病例提醒在癌症病人發生不明原因之呼吸困難時需考慮肺部淋巴管炎癌細胞轉移之可能性，建議找早期給予積極性化學治療。

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並列摘要

Pulmonary lymphangitic carcinomatosis (LC) is defined as the presence of tumor cells in the pulmonary lymphatic vessels and lung interstitium. Pulmonary LC is a rare form of lung metastasis from rectal cancer. Here, we report the case of a 57- year-old woman who developed dyspnea after neoadjuvant concurrent chemoradiation therapy (CCRT) for rectal cancer. Chest radiographs revealed bilateral reticulonodular infiltrates and pleural effusion but no obvious nodules. The patient was treated as a case of pneumonia initially but the dyspnea worsened rapidly. For lack of bacterial growth from sputum culture, and on account of the cytological examination of the pleural effusion which revealed malignant cells. pulmonary LC was suspected and systemic chemotherapy was prescribed; however, the treatment was ineffective and the patient died of acute progressive respiratory failure. We suggest if a patient having cancer presents with respiratory compromise and increased bilateral infiltration and/or reticulonodular changes on chest radiographs, the possibility of pulmonary LC should be considered. If the patient treated as a case of pneumonia or other benign diseases, has a rapidly worsening clinical course, early diagnosis and aggressive chemotherapy are essential for the proper management of pulmonary LC.

並列關鍵字

lymphangitic carcinomatosis ； metastasis ； rectal cancer

國際替代計量

Pulmonary Lymphangitic Carcinomatosis from Rectal Cancer: Report of a Case

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