Lymphangitic Carcinomatosis of the Lungs

The Clinical Significance of Its Roentgenologic Classification

¹ National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China

Sixty-two cases of proved pulmonary lymphangitic carcinomatosis were studied with special reference to the clinico-roentgenologic evolution. They are classified into four types based on the pattern of chest x-ray findings and mode of evolution. In Type I (eight cases), progressive diffuse linear shadows of reticular appearance in both lung fields without hilar enlargement, all proved to be lung metastases from stomach cancer. The study suggests the way of lymphatic spread through the diaphragm and pleural shadows from bilateral enlarged hili, consists of metastases from the stomach (five cases), cervix (six cases), breast (four cases), as well as nasopharynx, prostate, pancreas and thyroid. It suggests pulmonary lymphatic spread has followed the bilateral hilar lymph node metastases. Type III (15 cases), showing a pattern of lymphatic spread from one portion of the lung to the other, proved to be hilar type bronchogenic carcinoma. Type IV (19 cases), which differed from Type III by a mass shadow in the lung parenchyma proved to be lymphatic spread of parenchymal type bronchogenic carcinoma. The histologic type of 31 (including two cytologically proved cases) of 34 cases of bronchogenic carcinoma showing lymphatic spread was adenocardinoma. This classification, therefore, has clinical significance in predicting the primary site and histologic type of the cancer.