Diagnosis of Lymphangitis Carcinomatosa Using Cryobiopsy after Surgical Treatment for Lung Adenocarcinoma

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Lymphangitis carcinomatosa is a type of pulmonary metastasis with a poor prognosis. Transbronchial lung biopsy and bronchoalveolar lavage (BAL) are used for its histologic diagnosis, but improved diagnostic yield is needed. Transbronchial lung cryobiopsy (TBLC) is useful in diagnosing interstitial lung diseases and might be useful in diagnosing lymphatic invasion of tumor cells. A 60-year-old man presented with low-grade fever and dyspnea 1 year after a right lower lobectomy. Chest computed tomography showed generalized ground-glass opacities in his lungs. Bronchoscopy was performed for a definitive diagnosis of ground-glass opacites following ineffective antimicrobial therapy. BAL showed no malignant cells, and TBLC showed tumor cells infiltrating the lymphatic vessels. Multiplex polymerase chain reaction testing was available for the TBLC specimen, and treatment based on genetic test results was introduced. In conclusion, TBLC enabled a clear diagnosis of lymphatic invasion of tumor cells and enabled multiplex examinations. TBLC is a useful tool for respiratory endoscopists in diagnosing lymphangitis carcinomatosa.