Pulmonary lymphangitic carcinomatosis in renal adenocarcinoma

Lymphatic permeation of the lungs has been described in the terminal phases of carcinoma of the breast, stomach, colon, pancreas, prostate, endometrium, ovary, cervix and bladder (Fraser and Pare, 1970; Heitzman, 1973; Janover and Blenner-hasset, 1971). This type of metastatic dissemination from a renal adenocarcinoma has not been previously documented. A 39-year-old black male presented with two weeks' intermittent epigastric and right flank pain. The initial laboratory work-up was non-contributory. The admission chest X ray was normal (Fig. 1a). An excretory urogram and nephrotomogram showed a bulbous right upper pole with calyceal amputation. A selective renal arteriogram with and without epinephrine revealed a minimally vascularized solid mass without evidence of arteriovenous shunting or tumour staining. While undergoing further diagnostic work-up, there was marked progression of the clinical symptoms.