Afatinib treatment of severe respiratory failure due to malignant lymphangitis in a dialysis patient with squamous cell carcinoma of the lung.

Patients on dialysis have limited treatment options for advanced lung cancer because some chemotherapeutic agents are unavailable due to renal dysfunction. A man in his 70s on peritoneal dialysis presented with persistent fever refractory to antibiotics for 2 weeks. Subsequent whole-body CT showed a 5 cm diameter mass in the right lower lobe of the lung with right-sided pleural effusion and osteolytic metastasis of the right iliac bone. The patient was diagnosed with squamous cell carcinoma (cT3N2M1b, stage IVB) harbouring the p.Gly719Ala point mutation on exon 18 of the epidermal growth factor receptor. The patient developed severe respiratory failure due to malignant lymphangitis after a bronchoscopy. He received 30 mg/day of afatinib, resulting in tumour shrinkage and recovery from respiratory failure. We advocate for aggressive screening of driver oncogenes in patients with lung cancer on dialysis, including those with squamous cell lung cancer.

Pulmonary lymphangitis carcinomatosis: A peculiar presentation clustering in MET-amplified gastric cancer.

BACKGROUND: The clinicopathological features of MET-amplified gastric cancer (GC) and real-world data on the efficacy of MET-targeted therapies remain unknown. Pulmonary lymphangitis carcinomatosis (PLC) is a peculiar manifestation of GC, whose management has not been thoroughly described. METHODS: This study analyzed patients diagnosed with MET-amplified GC or GC with PLC at any time point of the disease course from 2011 to 2021 in two centers. Clinicopathological features and survival outcomes of MET-amplified GC were analyzed. The clinical and molecular implications of GC with PLC were discussed. RESULTS: Fifty-eight patients with MET-amplified GC and 20 patients with GC accompanied by PLC were finally enrolled for analysis (including 13 overlapped patients). GC with PLC was more common in female patients (p = 0.010), diagnosed at a younger age (p = 0.002), presented with a higher baseline ECOG PS (p = 0.016), and was more likely to develop lung metastasis (p < 0.001), and serous effusion (p = 0.026) than GC without PLC. Patients with primary MET-amplified GC had a worse prognosis than those with secondary MET-amplified GC (p = 0.005). The application of anti-MET therapy was associated with numerically prolonged survival, but the association was not statistically significant (p = 0.07). MET amplification was concentrated in patients with PLC, in which anti-MET therapies elicited a high response rate. CONCLUSIONS: MET-targeted therapies are efficacious in real-world populations with MET-amplified GC. Patients with PLC have distinct clinical and molecular features and might benefit from MET-targeted therapies.

[A Case of Gastric Cancer with Pulmonary Carcinomatous Lymphangitis and Disseminated Carcinomatosis of the Bone Marrow Responding to S-1 plus Cisplatin Chemotherapy].

A 63-year-old man was admitted to a hospital owing to shortness of breath. He was diagnosed as having gastric cancer with pulmonary carcinomatous lymphangitis(PCL)and disseminated carcinomatosis of the bone marrow(DCBM). Regarding tumor markers, carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels increased to 332 ng/ mL and 921 U/mL, respectively. Since the disease was also accompanied by disseminated intravascular coagulation(DIC), S- 1 plus cisplatin chemotherapy was started immediately(S-1 120 mg/body administered for 21 days and cisplatin 60 mg/m2 administered on day 8, 35 days for a course). Approximately 2 weeks after the initiation of chemotherapy, the patient's respiratory symptoms improved, and he recovered from DIC. After 2 chemotherapy courses, tumor marker levels decreased (CEA 9.3 ng/mL and CA19-9 314 U/mL), and the patient continued to receive chemotherapy without the deterioration of his physical condition for 5 months. However, he experienced fatigue after 4 courses, because of the progression of gastric cancer. Although the regimen was changed to ramucirumab plus paclitaxel chemotherapy, the patient died 8 months after the initiation of chemotherapy. An accumulation of cases is needed to establish treatment strategies for gastric cancer with PCL and/or DCBM.

Pulmonary tumour embolism and lymphangitis carcinomatosa: a case report and review of the literature.

BACKGROUND: Pulmonary tumour embolism and lymphangitis carcinomatosa are complications of malignancy that may mimic the clinical presentation of pulmonary embolism. CASE PRESENTATION: We present the case of a 52-year-old male patient with acute-onset right ventricular strain and dyspnoea with elevated D-dimer and without signs of pulmonary embolism on computed tomography pulmonary angiogram (CTPA) and ventilation/perfusion scintigraphy. The patient died eleven days after initial presentation. The diagnosis of pulmonary tumour embolism and lymphangitis carcinomatosa due to carcinoma of unknown origin was made post-mortem by immunohistochemical examination. CONCLUSION: Pulmonary tumour embolism and lymphangitis carcinomaosa are complications of malignancy and potential causes of acute right ventricular strain. Radiological signs are unspecific and the clinical course usually fatal. These differential diagnoses should be considered in patients with acute right ventricular strain, dyspnoea and positive D-dimer if there are no signs of pulmonary embolism on CTPA.

Mite bites, comet signs and possible mammary prosthesis rejection after returning to a vacation home: a diagnostic challenge.

Pyemotes ventricosus is a free-living mite feeding on larvae or nymphs of insects, including moths, beetles, wasps and bees, that are usually found in grain, straw and firewood. When present in great number or when its food is lacking, it could accidentally bite mammals, including humans, causing a highly pruritic self-limiting dermatitis, sometimes followed by a lymphangitis known as "comet sign".We present a singular case of mite lymphangitis that surrounds and delimitates breast prosthesis in a 30-year-old Caucasian woman. Other bite in the lower abdomen did not present comet sign. The patient got the infestation in her vacation home in the South of Italy, uninhabited for 10 months since COVID-19 confinement. We hypothesize that the previous surgery made the lymphatic vessels more prone to inflammation and we compare other insect bites that can occur vacationing in a long period uninhabited room.A delayed diagnosis of comet sign implies a retarded fumigation allowing new mite bites and, in this case, extends the patient's preoccupation about the prosthesis rejection.

Is lymphangitic streaking associated with different pathogens?

OBJECTIVES: Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis. METHODS: Retrospective cross-sectional study at a tertiary pediatric emergency department over 25 years. We opted to assess patients with paronychia of the finger, assuming that these cases will have a greater variety of causative pathogens compared to other cases of cellulitis and soft tissue abscess that are associated with nail biting. Case identification was conducted using a computerized text-screening search that was refined by manual chart review. We included patients from 1 month to 20 years of age who underwent an incision and drainage (I&D) of a paronychia and had a culture obtained. The presence or absence of lymphangitis was determined from the clinical narrative in the medical record. We excluded patients treated with antibiotics prior to I&D as well as immune-compromised patients. We used descriptive statistics for prevalence and χ2 tests for categorical variables. RESULTS: Two hundred sixty-six patients met inclusion criteria. The median age was 9.7 years [IQR 4.7, 15.4] and 45.1% were female. Twenty-two patients (8.3%) had lymphangitic streaking associated with their paronychia. Patients with lymphangitis streaking were similar to those without lymphangitis in terms of age and sex (p = 0.52 and p = 0.82, respectively). Overall, the predominant bacteria was MSSA (40%) followed by MRSA (26%). No significant differences were found between the pathogens in the 22 patients with associated lymphangitis compared to the 244 patients without. CONCLUSION: Staphylococcus aureus represent the majority of pathogens in paronychia, although streptococcal species and gram-negative bacteria were also common. Among patients with paronychia of the finger, there seems to be no association between pathogen type and presence of lymphangitic streaking.

Linfangitis aguda tubular por Rickettsia sibirica mongolitimonae / Tubular acute lymphangitis caused by Rickettsia sibirica mongolitimonae

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Pulmonary lymphangitic carcinomatosis without concurrent liver metastasis from colon cancer detected using 18F-FDG PET/CT: A case report.

RATIONALE: The infiltration of tumor cells to pulmonary lymphatic system, as known as pulmonary lymphangitis carcinomatosis (PLC), is a rare presentation of pulmonary metastases. PATIENT CONCERNS: We reported a case of a 66-year-old man after surgery, chemotherapy, and radiation therapy for colon cancer. Two months after these therapies, the patient complained of nonproductive cough for 1 week. DIAGNOSES: 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scanning revealed increased FDG uptake along the thickened bronchovascular bundles, in bilaterally scattered ground-glass opacities and in mediastinal lymphadenopathy. The transbronchial biopsy and pathological study confirmed the diagnosis of PLC. INTERVENTIONS: Antineoplastic treatment (cetuximab) were administered after the patient was diagnosed with PLC. OUTCOMES: The patient died of respiratory failure within 3 months after the onset of his symptom. LESSONS: 18F-FDG PET/CT play an important role in identifying PLC, in selecting possible biopsy sites, and in accessing the extent of metastatic disease.