[A case of pulmonary carcinomatous lymphangiosis exhibiting multiple patchy opacities, caused by CA 19-9 producing metastatic stomach cancer].

A 64-year-old man was admitted to our hospital complaining of Hugh-Jones II dyspnea. Chest CT showed multiple diffuse patchy shadows in both lung fields. A diagnosis of pulmonary carcinomatous lymphangiosis was made on the basis of the presence of adenocarcinoma cells within the lymphatic vessels in transbronchial lung biopsy (TBLB) specimens. The primary site was a tumor in the stomach. It is very rare for pulmonary carcinomatous lymphangiosis to show multiple patchy shadows in CT. Tumor cells were positive for CA 19-9. There were high titers of carbohydrate antigens, SPAN-1, CA 19-9, SLX, CA 125 and CA 724 both in the bronchial alveolar fluid (BALF) and in the serum. SPAN-1, CA 19-9 and SLX titers were higher in the BALF than in the serum. In this case, liver metastasis had also occurred with carcinomatous lymphangiosis. This case is very interesting in that type I and II carbohydrate antigens were correlated with blood-borne metastasis.