Pulmonary lymphangitic carcinomatosis-An experience at autopsy

Background: Pulmonary lymphangitic carcinomatosis is an uncommon mode of metastases, characterized by diffuse infiltration of the lymphatics malignant cells, and is mainly the subject of case reports or a few case series.

Aims: The aim of this study is to study the clinicopathological features of this entity at autopsy.

Materials and methods: This is a retrospective study of data collected over an 11-year period at a tertiary-care hospital. Clinicopathological data of all autopsies with lymphangitic carcinomatosis were analyzed with reference to their demographics, clinical presentation, investigations, sites of primary cancer, and other relevant findings at autopsy.

Results: Among 255 cases of malignancies encountered in 7521 autopsies during the study period, 43 patients (16.9%) showed pulmonary metastasis with 22 (13 females and 9 males, mean age of 52.04 years) histologically proven lymphangitic carcinomatosis of the lungs. An antemortem diagnosis was made in only 1 of the 22 cases. The most common sites of carcinoma had been the stomach or the lungs (40.9%) and dyspnea had been the main symptom. The lungs, in addition, showed metastatic deposits and arterial thrombi and/or tumor emboli. The most common nonpulmonary site for metastasis was the liver and lymph nodes.

Conclusions: Pulmonary lymphangitic carcinomatosis is often an underdiagnosed clinical entity and the presence of acute progressive respiratory failure in patients with epithelial cancers should raise clinical suspicion. This is one of the largest series to be reported at autopsy.