Cancer Lymphangitis Carcinomatosis

This is a post mortem specimen of a lung with lymphangitic spread of prostate carcinoma. Malignant disease is overlaid in green. Note the rounded mass of lymphadenopathy with linear extensions along the thickened bronchovascular bundles. The fine linear bands peripherally are lymphatics congested with tumor.
Ashley Davidoff MD
lungs pulmonary parenchymal mass neoplasm primary lymphatics distended metastases lymphangitis gross pathology
This histological section is from a patient with protate cancer metastatic to the lymphatics of the lungs – lymphangitis obliterans. The first image shows thickened lymphatics which run in the interlobular septa, overlaid in green in (2). Images 3, and 4 are higher power showing clusters of glandular metatstatic deposits.
Ashley Davidoff MD
lungs pulmonary neoplasm primary prostate lymphatics distended metastases lymphangitis histopathology


This is a patient with lung carcinoma presenting with a large mass in the right upper lobe with a lymphangitic pattern, adrenal metastasis and a PET positive scan for the mass and for the left adrenal gland.
Ashley Davidoff MD
32269b see 680249
lungs pulmonary mass RUL neoplasm malignant primary lymphatics lymphangitis imaging plain film CXR CTscan PETscan
Structural Consequences of Central Disease
The CT scan of the centrally positioned small cell carcinoma has structural implication as a result of its central location close to large arteries, veins, airways and lymphatics. In this case the centrally placed tumor (dark green in image b) is pushing on the right mainstem bronchus (shown with white arrow) and the lymphatics with peribronchial thickening (image d light green) and extension into the interlobular septa (bright green in d) Subcarinal nodal involvement and left hilar involvement (light green in b)together with small right effusion (a,b) are also noted suggesting advanced disease.
Ashley Davidoff
CT in the axial plane demonstrates a large, spiculated mass in the right upper lobe likely reflecting hemorrhage around the mass. In addition there is evidence of interlobular septal thickening, and secondary changes in the right major fissure possibly reflecting lymphatic invasion and raising the possibility of lymphangitis carcinomatosis
Ashley Davidoff MD
Small Cell Lung Carcinoma
This collage of CT and plain film represents the radiological history of a patient with poorly differentiated small cell carcinoma, with extensive parenchymal involvement of the RUL and RML, and of the airways of RML and RLL. Images 1 and 2 show an interstitial and pneumonic pattern which was persistent over time. The CT shows extensive endobronchial disease involving right main stem (3,4) as well as almost all segments of RLL. This was confirmed by bronchoscopy.
Lymphangitic disease seems to be the dominant finding in the RUL on the lung windows. (5).
Following stent placement through a “pinhole” lesion, the patient occluded the RUL airways with tracheal shift and hyperinflation of the left lung (6,7,8,9). Clinically however, she improved greatly.
Courtesy Ashley Davidoff MD.
This CT collage represents the radiological findings of the endobronchial spread of poorly differentiated small cell carcinoma with extensive tubular obstruction. Images 1, 2, and 3 (and corresponding green overlay) show a significantly narrowed lumen starting at the right mainstem and extending down into bronchus intermedius and segmental branches. These findings were confirmed at bronchoscopy. Aspirated contrast or calcified bronchioles to the RML and RLL outline the tumor filled bronchi with surprisingly little volume loss.
Courtesy Ashley Davidoff MD.
This CT collage represents the radiological findings of a patient with poorly differentiated small cell carcinoma, with extensive lymphangitic involvement of the RUL and occlusion of the airways of RML and RLL. Image 1 shows an emphysematous background involving the upper lobes, while image 2 shows lymphangitic disease of the RUL. A pinhole of air is surrounded by tumor and a calcified ring around the right mainstem bronchus, while the bronchus intermedius is totally occluded seen (calcified ring as well) with the lumen plugged by tumor and debris. These findings were confirmed by bronchoscopy. Note that the volume of the right lung is smaller than the left due to atelectatsis and the constricting effect of lymphangitis.
Courtesy Ashley Davidoff MD.
32426_03cl keywords
lung bronchus lyphatic infiltrate mass obstruction atelectasis thickening interlobular septa neoplasm malignant primary malignancy small cell carcinoma imaging radiology CTscan


Links and References