[A case of small cell carcinoma of the lung with carcinomatous lymphangiosis-like shadow].

A 60-year-old man was admitted to our hospital on January 29, 1991 with dry cough, shortness of breath on exertion, appetite loss and abnormal shadows on chest X-ray. Chest X-ray on admission showed marked vascular shadows in both lung fields accompanied by left interlobar effusion. Chest CT showed thickening of vessels and bronchial walls with prominent interlobular septa in the subpleural regions. These findings suggested that the lesions were located in the peribronchial and perivascular interstitium and interlobular septa. Biopsy specimens of bronchial epithelium, lung tissue and right supraclavicular lymph nodes revealed small cell carcinoma (intermediate cell type). Because of the absence of lesions in other organs, the initial diagnosis was carcinomatous lymphangiosis of small cell carcinoma of the lung. However, the mild symptoms, normal arterial blood gas and good response to chemotherapy suggested the possibility of extensive small cell carcinoma of longitudinal spread type. Although small cell carcinoma of the lung is not a rare disease, this case suggests two possibilities. 1) Carcinomatous lymphangiosis of small cell carcinoma may have different symptoms, clinical course and prognosis from that of non-small cell carcinoma. 2) Carcinomatous lymphangiosis of small cell carcinoma may not be a clinical entity and in fact may simply represent extensive small cell carcinoma of longitudinal spread type.