Pulmonary lymphangitic carcinomatosis: chronicity of radiographic findings in long-term survivors.

OBJECTIVE: Long-term survival after development of pulmonary lymphangitic carcinomatosis is considered unusual. However, modern chemotherapy can result in surprising stability or only gradual progression of lymphangitic carcinomatosis. We evaluated the course of radiographic findings in 10 patients with chronic lymphangitic carcinomatosis.

MATERIALS AND METHODS: Ten patients met our criterion of having lymphangitic carcinomatosis for at least 6 months. The primary tumor was a carcinoma of the breast in six cases, the ovary in two, the pancreas in one, and the skin in one. Serial radiographs (all cases) and CT scans (eight cases) were analyzed retrospectively.

RESULTS: Survival with lymphangitic carcinomatosis ranged from 11 to 30 months (median, 13 months). With chemotherapy, the radiographic abnormalities and pulmonary symptoms initially regressed in six patients, progressed in two, and remained unchanged in two; the radiographic findings of lymphangitic carcinomatosis were progressing at the time of death in four patients. All patients had periods of at least 4 months of relative stability or slow progression of pulmonary radiographic abnormalities. Serial transbronchial biopsies in one case confirmed persistent lymphangitic carcinomatosis despite therapy, and autopsy disclosed persistent lymphangitic tumor in two others.

CONCLUSION: Stability or slow progression of radiographic findings can occur in some patients with lymphangitic carcinomatosis. Therefore, chronicity of radiographic findings should not be taken as evidence against lymphangitic carcinomatosis as the cause of an interstitial abnormality in a patient with cancer.