PMC7703254_01
Timeline showing the treatments received, the CA 19-9 levels measured, and representative images from the CT scans of pulmonary and hepatic disease involvement. At diagnosis, the patient was found to have widespread hepatic metastases (bottom left). At the pretreatment scan, the index lesion (yellow arrow) had enlarged, but then decreased in size, along with a markedly improved CA 19-9 level. However, the patient had development and progression of pulmonary opacities (blue arrow). CT, computed tomography.
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Computed tomography (CT) scan of the chest, abdomen, and pelvis (CAP) showed a 4.3 x 4.2 x 4.0 cm mass in the tail of the pancreas, peripancreatic lymphadenopathy, and metastatic spread to the liver (Fig. 1).
Left lung showing diffuse metastatic nodular deposits and extensive hilar lymphadenopathy (blue arrow), with tumor growth beyond the lymphatic vessels resulting in lymphangitic spread with intersegmental infiltration (green arrow).
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The lungs demonstrated diffuse bilateral involvement by nodular (most <1 cm) and lymphangitic tumor deposits (Fig. 2).
Microscopic evaluation of lung demonstrated (A) multiple small nodular tumor deposits (<1 cm) throughout the lung parenchyma and (B) lymphangitic spread of tumor cells adjacent to a large pulmonary vessel (black arrows). (B) is the magnification of the region (yellow box) in (A).
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Microscopic examination showed aggregates of tumor cells expanding the periarterial lymphatic vessels (Fig. 3), consistent with pulmonary lymphangitic carcinomatosis (PLC).