Khachekian Arsineh, Shargh Sean, Arabian Sarkis
J Am Osteopath Assoc. 2015 May;115(5):332-7. doi: 10.7556/jaoa.2015.064.
Pulmonary lymphangitic carcinomatosis (PLC) is the diffuse infltration of lymphatic systems by adenocarcinomas. Because of its vague clinical symptoms and absence of malignant features, confrmatory diagnosis requires transbronchial or open-lung biopsy. Tumor spread is postulated to occur by means of retrograde lymphatic permeation with tumor growth along the lymphatic channels and involvement of vascular endothelial growth factor-C in a signaling pathway. The authors describe the case of a 45-year-old woman whose presentation with cough and dyspnea led to diagnosis of pulmonary lymphangitic carcinomatosis with superimposed pulmonary hypertension, tumor thrombotic microangiopathy, and ultimately metastatic signet ring cell gastric adenocarcinoma. Because of the patient's poor prognosis, she was given palliative care and died 29 days after admission. This case emphasizes the importance of the osteopathic principle of treating the whole patient and evaluating all organ systems. Physicians should be aware of PLC from gastric adenocarcinoma and consider it in patients with pulmonary symptoms who are unresponsive to antibiotics.
肺淋巴管癌病（PLC）是腺癌对淋巴系统的弥漫性浸润。由于其临床症状模糊且缺乏恶性特征，确诊需要经支气管活检或开胸肺活检。肿瘤扩散被推测是通过逆行性淋巴渗透，肿瘤沿淋巴管生长，并涉及血管内皮生长因子-C参与信号通路。作者描述了一名45岁女性的病例，她因咳嗽和呼吸困难就诊，诊断为肺淋巴管癌病合并肺动脉高压、肿瘤性血栓微血管病，最终为转移性印戒细胞胃腺癌。由于患者预后较差，给予了姑息治疗，入院29天后死亡。该病例强调了从整体治疗患者并评估所有器官系统的整骨疗法原则的重要性。医生应意识到胃腺癌导致的PLC，并在对抗生素无反应的肺部症状患者中考虑该病。
