Abstract
A 70-year-old woman was admitted with complaintsof a dry cough and dyspnea. Chest X-ray films revealedlinear and reticular patterns and interstitial pneumonitiswas suspected.
In the sputum, however, malignant cells were observed, which were small and round, containing large and hyperchromatic nuclei, appearing in loosely connected clusters forming in part characteristic “indian files”.
Because this patient had undergone right total mastectomy 17 years before, metastatic recurrence of breast carcinoma was suspected. A month later she developed respiratory distress and died.
The autopsied lungs revealed lymphangitic carcinomatosis. It showed adenocarcinoma of the medullotubular structure, which was consistent with the histology of previously removed breast cancer. Some cancer nests grew out of the lymphatic vessels around the bronchioles, infiltrated the mucosa and penetrated the lumen.
When pulmonary metastasis is blood-borne, tumor nests form detatched from the bronchial system, so sputum cytology is expected mostly to be negative. However, examination of sputum may be a useful diagnostic procedure in the case of lymphangitic carcinomatosis, considering the medical history stated above.
