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Imaging showed a right upper lobe tumor with bronchovascular bundle thickening and esophageal wall involvement, plus extensive lymph node and distant metastases including brain lesions. Diagnostic workup identified poorly differentiated adenocarcinoma with TTF-1 positivity and strong PD-L1 expression, without driver gene alterations. Autopsy confirmed diffuse lymphangitic spread with multiorgan involvement and suggested dissemination driven mainly by direct lymphatic invasion.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/rapidly-worsening-lung-adenocarcinoma-due-to-diffusely-spreading-lymphangitic-carcinomatosis-a-case-report/338334/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/rapidly-worsening-lung-adenocarcinoma-due-to-diffusely-spreading-lymphangitic-carcinomatosis-a-case-report/338334.png","ImageObject",300,407,{"name":92,"@type":93},"Sage","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical features marked the start of the case?","Question",{"text":113,"@type":114},"The patient presented with progressive dysphagia and dyspnea for 4 days.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What did imaging and endoscopic evaluation show?",{"text":118,"@type":114},"Radiography and CT showed a right upper lung tumor with bilateral reticulations, bronchovascular bundle thickening, and esophageal wall thickening. 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We present a case of rapidly worsening lung adenocarcinoma with diffusely spreading cancerous lymphangitis in lung, mediastinum, retroperitoneum, and gastrointestinal tract. Our findings suggest cancer dissemination in this patient was predominantly caused by direct lymphatic invasion.  \nKEYWORDS  \nautopsy, esophageal stenosis, lymphangitic carcinomatosis, non-small-cell lung carcinoma  \ntumors. Fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) demonstrated FDG uptake in  \nLymphangitic carcinomatosis is a metastatic disease with a poor prognosis and poorly understood pathophysiology. Here, we present a case of rapidly worsening lung adenocarcinoma with diffusely spreading cancerous lymphangitis, suggesting that cancer dissemination in this patient was predominantly caused by direct lymphatic invasion.  \n2 | CASE PRESENTATION  \nA 60-year-old man presented with progressive dysphagia and dyspnea for 4 days. He had an 80-pack-year smoking history. Chest radiography revealed a tumor in the right upper lung field and bilateral reticulations (Figure 1A) . Computed tomography (CT) revealed a tumor in the right upper lobe (Figure 1B1) with bilateral bronchovascular bundle thickening (Figure 1B2) and esophageal wall thickening (Figure 1B3) . Magnetic resonance imaging (MRI) showed multiple brain  \nthese lesions, as well as in the left adrenal gland, and thoracic and abdominal lymph nodes (Figure 1C1– C3) . Esophagogastroduodenoscopy (EGD) revealed esophageal stenosis with a relatively smooth epithelium (Figure 2A) and a duodenal ulcer (Figure 2B1) . Upon biopsy, only the duodenum yielded thyroid transcription factor-1 (TTF-1) positive adenocarcinoma cells in the lamina propria mucosae (Figure 2B2) . Endobronchial ultrasound-guided transbronchial biopsy with a guidesheath (EBUS-GS-TBB) of the right upper lobe tumor revealed TTF-1 positive poorly differentiated adenocarcinoma (Figure 2C), which was strongly positive for programmed death-ligand 1 (PD-L1) . However, no driver gene abnormality was detected on the Oncomine™ Dx Target Test. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the esophagus (Figure 2D1) revealed adenocarcinoma cells (Figure 2D2) . Based on these findings, the patient was diagnosed with right upper lobe lung adenocarcinoma,  \nThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.  \n© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.  \nClin Case Rep. 2024;12:e9494 .  \n[https://doi.org/10.1002/ccr3.9494](https://doi.org/10.1002/ccr3.9494)  \n[wileyonlinelibrary.com/journal/ccr3](wileyonlinelibrary.com/journal/ccr3)  \n1 of 4  \ncT4N3M1c2, cStage IVB (BRA, LYM, ADR, OTH; esophagus, and duodenum) (UICC-9th edition) with pulmonary lymphangitic carcinomatosis.  \nTreatments included corticosteroid administration, stereotactic brain irradiation, and percutaneous endoscopic gastrostomy. While the respiratory symptoms temporarily improved, then eventually worsened. Forty days after the first visit, the pati","cbCaimRumC6g6k3n","https://ap.wps.com/l/cbCaimRumC6g6k3n","pdf",3470064,"English","# Introduction\n# Case presentation\n# Discussion","[{\"question\":\"What clinical features marked the start of the case?\",\"answer\":\"The patient presented with progressive dysphagia and dyspnea for 4 days.\"},{\"question\":\"What did imaging and endoscopic evaluation show?\",\"answer\":\"Radiography and CT showed a right upper lung tumor with bilateral reticulations, bronchovascular bundle thickening, and esophageal wall thickening. EGD revealed esophageal stenosis and a duodenal ulcer.\"},{\"question\":\"How was disseminated disease explained in the report?\",\"answer\":\"Findings suggested that cancer dissemination was predominantly caused by direct lymphatic invasion, leading to diffuse lymphangitic spread across lung and multiple organs.\"}]","Rapidly worsening lung adenocarcinoma due to diffusely spreading lymphangitic carcinomatosis - A case report | PDF",1790023107]