Lymphangiosis carcinomatosa
| Classification according to ICD-10 | |
|---|---|
| C49 | Malignant growth of other connective tissue and other soft tissue |
| C49.9 | Connective and other soft tissue, unspecified lymphangiosis carcinomatosa |
| ICD-10 online (WHO version 2019) | |
The term lymphangiosis carcinomatosa (LC) describes an infiltration of the lymphatic vessels by tumor cells. The clinically most important form is the pulmonary lymphangitis carcinomatosis , which is discussed below and are a special form of lung - metastases ( Pulmo ( lat. Group) =, lungs'). The main clinical symptom of pulmonary lymphangiosis carcinomatosa is a shortage of air ( dyspnoea ).
Pathogenesis, causes of pulmonary lymphangiosis carcinomatosa
A lymphangiosis carcinomatosis can affect both lungs or only parts of it. The most common cause is metastatic breast cancer (breast cancer). Other tumors can also lead to LC, for example bronchial carcinoma (lung cancer), pancreatic carcinoma (pancreatic cancer) or prostate carcinoma . In the microscopic image of the affected lung sections, tumor cell masses are found in the lymphatic tract. The tumor cells mean that lymph drainage is no longer guaranteed. This leads to a build-up of fluid in the sections of the lungs drained by the corresponding lymphatic tracts, and to narrowing of the small branches of the lungs ( bronchioles ) and deterioration in the elasticity of the lungs and blood flow to the lungs. The resulting worsened gas exchange in the lungs leads to a feeling of lack of air.
The following types of pulmonary lymphangiosis carcinomatosa are distinguished:
- In the hilifugal metastasis type , the tumor cells spread from the hilar lymph node metastases against the lymph drainage into the periphery. From there the tumor breaks into the interstitium. Radially streaky parenchymal densities develop, which are typically found in carcinomas of the breast, the lungs and the gastrointestinal tract.
- In the hematogeno-embolic metastasis type , metastases from extrapulmonary tumors are washed into the capillary network of the lungs and from there infiltrate the lymphatic vessels and the interstitium.
- Perifocal type of metastasis : Regardless of its location in the lungs, lung cancer can lead to lymphangiosis carcinomatosa starting at the perifocal point.
Diagnostics and differential diagnoses in suspected pulmonary lymphangiosis carcinomatosa
There are no blood values that are specific for lymphangiosis carcinomatosa. Under certain circumstances an increase in tumor markers can be measured. The pulmonary function examination shows a clear restrictive ventilation disorder . The most important diagnostic test is the chest - x-ray and computed tomography (CT) of the chest. There you can typically see a network-like drawing with fine, nodular condensation. Often there is also a pleural effusion . The differential diagnoses (“atypical” or viral pneumonia , capillary leak syndrome , pulmonary congestion ) can sometimes be difficult to differentiate. In case of doubt, a bronchoscopy with tissue sampling ( biopsy ) from the affected lung sections can possibly provide clarification.
Treatment of pulmonary LC
The treatment of lymphangiosis carcinomatosa is based on the symptoms and aims to relieve the shortage of air. For this purpose, higher doses of glucocorticoids ("cortisone"), loop diuretics for drainage and, if necessary, theophylline are given. On the other hand, the tumor disease should be treated with appropriate cytostatics . This often leads to a significant improvement in the symptoms. At this stage, however, the tumor disease is usually no longer curable.
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- EM Kirchner, J. Kirchner, S. Petrasch: Pulmonary Lymphangiosis carcinomatosa. In: The oncologist. Volume 13, Issue 12, December 2007, Springer-Verlag
