Rapidly worsening lung adenocarcinoma due to diffusely spreading lymphangitic carcinomatosis: A case report

Figures

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  FIGURE 1. Radiological findings on admission. (A) Chest radiograph showing a tumor in the right upper lung field and bilateral reticulations. (B) Computed tomography (CT) revealing a tumor in the right upper lobe (B1), thickening of the bilateral bronchovascular bundles (B2), and thickening of the esophageal wall (B3, indicated by an arrow). (C) Fluorodeoxyglucose positron emission tomography/CT (FDG‐PET/CT) demonstrating FDG uptake in the tumor in the right upper lobe, thickened bilateral bronchovascular bundles, thickened esophageal wall, left adrenal gland, thoracic and abdominal lymph nodes, and brain tumors (C1–C3).

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  FIGURE 2. Esophagogastroduodenoscopic (EGD) and Bronchoscopic findings. (A) EGD showing esophageal stenosis, characterized by a relatively smooth epithelium. (B) An ulcer in the duodenum is identified (B1). Biopsy revealed adenocarcinoma cells in the lamina propria mucosae (B2, hematoxylin and eosin (H&E) staining ×100, indicated by arrows). (C) Endobronchial ultrasound‐guided transbronchial biopsy with a guide sheath (EBUS‐GS‐TBB) of a right upper lobe tumor containing poorly differentiated adenocarcinoma (H&E staining ×200). (D) Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) of the esophagus (D1) showing adenocarcinoma cells (D2, H&E staining ×200).

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  FIGURE 3. Pathological autopsy findings. (A) Macroscopic examination of the lung revealed a right upper lobe tumor (indicated by an arrow) and bilateral bronchovascular bundle thickening throughout the lung (A1). The right upper lobe tumor consists of poorly differentiated adenocarcinoma (A2, H&E staining ×200). The autopsy specimen from the left lower lobe reveals enlarged lymphatic vessels filled with adenocarcinoma cells (A3, H&E staining ×200). (B) The esophageal wall appears stiffened and thickened (B1, indicated by arrows). Carcinomatous cells can be seen diffusely in lamina propria (B2, H&E staining ×100), whereas no obvious carcinomatous cells were seen in stratified squamous epithelium (B3, H&E staining ×200). (C) The jejunum contains multiple nodes (C1, indicated by an arrow). Carcinomatous cells are seen in the lymphatic vessels (C2, H&E staining ×200). (D) Diffuse adenocarcinoma in the stroma surrounding the thyroid follicles (H&E staining ×200). (E) Carcinomatous cells are found in the lymphatic vessels of the myocardium (H&E staining ×200). (F) Diffuse carcinomatous cells in the adrenal glands (H&E staining ×200).