Pulmonary lymphangitic carcinomatosis as a primary manifestation of gastric carcinoma in a young adult: a case report and review of the literature

We present a case of a 24 year old male with progressive dyspnea. Initial radiologic assessment suggested interstitial lung disease, which was subsequently treated with antibiotics and corticosteroids. However, endoscopy and whole body diffusion-weighted magnetic resonance imaging revealed a metastatic gastric cancer with the presence of lymphangitic carcinomatosis.Pulmonary lymphangitic carcinomatosis is a rare manifestation of metastatic gastric cancer. Patients present with severe but non-specific respiratory complaints. Definitive diagnosis can be achieved by transbronchial biopsy. Prognosis is poor and optimal treatment is not defined. Whole body diffusion-weighted magnetic resonance imaging is a promising imaging tool for the diagnosis of metastatic gastric cancer.Pulmonary lymphangitic carcinomatosis is present in 6-8% of patients with lung metastases [1]. Infiltration of the pleural, peribronchial and perivascular lymphatics by neoplastic cells was first noted in 1829. The histopathology was described in detail in 1874. The spread of tumour cells to the pulmonary lymphatic system or the adjacent interstitial tissue results in thickening of the bronchovascular bundles and septa. Desmoplastic reaction, due to proliferation of neoplastic cells and lymphatic dilatation by edema fluid or tumour secretions contribute to this interstitial thickening [2]. Spread of the neoplasm outside the interstitium and lymphatic spaces into the adjacent parenchyma can result in a nodular pattern [2].Herein we report a very rare case of lymphangitic carcinomatosis as a primary manifestation of gastric carcinoma in a young adult.A 24 year old man presented at the emergency department after an episode of hemoptysis. For six months he complained about a dry cough. There was no respiratory-related pain but he had experienced shortness of breath during exercise for four weeks. He had not suffered from any fever or chills in the last six months. He reported occasional night sweats in t