Kashihara Eriko, Kanai Osamu, Okamura Misato, Mio Tadashi
Division of General Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
BMJ Case Rep. 2018 Apr 19;2018:bcr-2018-224206. doi: 10.1136/bcr-2018-224206.
Cutaneous lymphangitis carcinomatosa (CLC) is a rare form of cutaneous metastasis that causes lymphoedema and various eruptions. We report a case of lung cancer with CLC that caused both superior vena cava (SVC) stenosis and cervicofacial oedema, suggestive of SVC syndrome. A 64-year-old woman with lung adenocarcinoma presented with cervicofacial oedema and erythema, followed by severe dyspnoea 2 months after four cycles of carboplatin, pemetrexed and bevacizumab triplet therapy. Although chest CT indicated SVC stenosis, cervicofacial oedema remained despite treating the SVC stenosis via balloon dilation. A skin biopsy of the erythematic sample confirmed CLC as the cause of the patient's symptoms. CLC should be considered as a differential diagnosis of cervicofacial oedema in addition to SVC syndrome, especially when it is observed in combination with skin erythema and induration. Moreover, a skin biopsy should be performed promptly for accurate diagnosis of CLC and to decide on appropriate treatment.
皮肤淋巴管癌病（CLC）是一种罕见的皮肤转移形式，可导致淋巴水肿和各种皮疹。我们报告一例患有CLC的肺癌病例，该病例导致上腔静脉（SVC）狭窄和颈面部水肿，提示SVC综合征。一名64岁的肺腺癌女性患者在接受四个周期的卡铂、培美曲塞和贝伐单抗三联疗法后2个月，出现颈面部水肿和红斑，随后出现严重呼吸困难。尽管胸部CT显示SVC狭窄，但尽管通过球囊扩张治疗了SVC狭窄，颈面部水肿仍持续存在。对红斑样本进行皮肤活检证实CLC是患者症状的病因。除SVC综合征外，CLC也应被视为颈面部水肿的鉴别诊断，尤其是当它与皮肤红斑和硬结同时出现时。此外，应及时进行皮肤活检以准确诊断CLC并决定适当的治疗方法。
