A clinico-pathological study of the mode of evolution of lymphangiosis carcinomatosa of the lung.

Satoh Takashi, Matsubara Osamu, Kasuga Tsutomu

doi:10.11389/jjrs1963.26.12_1243

Thirty-three autopsied cases with lymphangiosis carcinomatosa of the lung seen at our institution from 1977 through 1987 were reviewed. The patients, 18 men and 15 women, ranged in age from 29 to 86 years, and the mean age was 56 years. The mean duration from the onset of respiratory symptoms to death was 8 weeks. Direct causes of death were respiratory failure in 21 cases, cachexia (3 cases), hepatic failure (2), pericarditis carcinomatosa, metastases to the brain, massive hemorrhage and DIC (1).<br>The primary sites of carcinomas were the stomach in 19 cases, breast (3), prostate (2), esophagus, rectum colon, lung, bile duct, oral cavity, maxillary sinus and ureter (1). The histological types were adenocarcinoma in 28 cases, squamous cell carcinoma in 4 and transitional cell carcinoma in 1. Pleural effusion was noticed in 27 cases, tumor thrombi were seen in the blood vessels in 13 cases, and the distribution of lymphangiosis was predominant in the lower lobes in 13 cases. Diaphragmatic penetration of tumor cells was microscopically observed in 10 out of 13 cases examined. In areas where changes of lymphangiosis were prominent, alveolar walls showed fibrous thickening in 16 cases and edematous thickening (13), and alveolar ducts were accompanied by hyaline membrane (4).<br>Macroscopic and microscopic spreading patterns of lymphangiosis in lungs could be classified into four types; subpleural, hilo-bronchial, mixed and intrapulmonary types. The subpleural type in 12 cases showed a spreading pattern mainly in the pleura and subpleural region. The hilo-bronchial type in 4 cases showed a spreading pattern along bronchial trees from metastatic hilar lymph nodes. The mixed type in 15 cases had a spreading pattern of both subpleural and hilo-bronchial types. The intrapulmonary type in 2 cases had a pattern of intrapulmonary spread with neither hilar nodal metastasis nor pleural involvement.<br>The duration from the onset of respiratory symptoms to death was shorter in cases of the subpleural type than in those of the hilo-bronchial type. The ratio of respiratory failure in the causes of death was 80% of the cases of the mixed type, and occupied 50% of cases of other types. Pleural and subpleural lymphangiosis was prominent in the cases of subpleural and mixed types. Alveolar changes were more frequent in the cases of the mixed type than those of other types. The diaphragmatic penetration was more common in the subpleural (6 out of 7 cases; 86%) and mixed types (4 out of 4 cases; 100%) than in the hilo-bronchial and intrapulmonary types (0 out of 2 cases).

A clinico-pathological study of the mode of evolution of lymphangiosis carcinomatosa of the lung.

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