Frontiers in medicine · 2026
Pulmonary lymphangitic carcinomatosis and pathological fracture as the initial manifestations of occult gastric adenocarcinoma mimicking interstitial lung disease: a case report and review of the literature.
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Yan Yan-Feng, Qi Wen-Xia, Tian Jie-Xiang, Wei Cai-Hong, Cui Yong-Hui
Аннотация
BACKGROUND: Pulmonary lymphangitic carcinomatosis (PLC) clinically and radiologically mimics interstitial lung disease (ILD), posing diagnostic challenges when the primary malignancy is occult.
CASE PRESENTATION: A 33-year-old male presented with progressive cough, dyspnea, and a rib fracture following minimal trauma. Chest CT showed bilateral interlobular septal thickening and mediastinal lymphadenopathy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of subcarinal nodes confirmed metastatic adenocarcinoma, with immunohistochemistry (CK7+,TTF-1-, Napsin A-) suggesting gastrointestinal origin. Subsequent PET-CT and gastroscopy identified a 4.0 cm gastric angulus tumor, biopsied as moderately to poorly differentiated adenocarcinoma with signet-ring cells. Despite first-line and second-line chemotherapy with transient improvement, rapid progression ensued. The patient died on February 18, 2025, with an overall survival of approximately 6 months from metastatic diagnosis.
CONCLUSION: This case illustrates that in young patients with ILD-like imaging and low-energy fractures, PLC warrants consideration even without gastrointestinal symptoms. Early use of EBUS-TBNA and PET-CT may facilitate timely diagnosis in appropriate clinical settings. Signet-ring cell-associated PLC carries a dismal prognosis, and transient responses should not be misconstrued as long-term benefit.
CASE PRESENTATION: A 33-year-old male presented with progressive cough, dyspnea, and a rib fracture following minimal trauma. Chest CT showed bilateral interlobular septal thickening and mediastinal lymphadenopathy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of subcarinal nodes confirmed metastatic adenocarcinoma, with immunohistochemistry (CK7+,TTF-1-, Napsin A-) suggesting gastrointestinal origin. Subsequent PET-CT and gastroscopy identified a 4.0 cm gastric angulus tumor, biopsied as moderately to poorly differentiated adenocarcinoma with signet-ring cells. Despite first-line and second-line chemotherapy with transient improvement, rapid progression ensued. The patient died on February 18, 2025, with an overall survival of approximately 6 months from metastatic diagnosis.
CONCLUSION: This case illustrates that in young patients with ILD-like imaging and low-energy fractures, PLC warrants consideration even without gastrointestinal symptoms. Early use of EBUS-TBNA and PET-CT may facilitate timely diagnosis in appropriate clinical settings. Signet-ring cell-associated PLC carries a dismal prognosis, and transient responses should not be misconstrued as long-term benefit.