A Case of Pulmonary Lymphangitis Carcinomatosis after Treatment of Multiple Cervical Lymph Node Metastasis from Tongue Cancer

Pulmonary lymphangitis carcinomatosis is a condition in which cancer cells invade the lymphatic vessels and cause multiple emboli, and has an extremely poor prognosis clinically. The most common primary sites of pulmonary lymphangitis carcinomatosis are the breasts, stomach, and lungs. The number of cervical lymph node metastases, extranodal invasion, and metastasis to levels Ⅳ and Ⅴ have been reported to be involved in the distant metastasis and prognosis of oral squamous cell carcinoma. We report a case of pulmonary lymphangitis carcinomatosis after treatment of multiple cervical lymph node metastasis from tongue cancer. Multiple cervical lymph node metastasis appeared in a 72-year-old male patient 4 months after partial resection for T2N0M0 oral tongue squamous cell carcinoma. We diagnosed rT0N3bM0 oral tongue squamous cell carcinoma, and he underwent radical neck dissection under general anesthesia. Histopathological examination revealed 47 metastatic lymph nodes in the dissected tissue and concurrent chemoradiotherapy was performed as postoperative adjuvant therapy. He complained of increased sputum and respiratory distress on the sixth day after the end of therapy. A chest CT scan showed thickened alveolar septa in both lungs, pleural effusion and enlarged hilar lymph nodes. Based on the findings of pleural effusion cytology and chest CT, we diagnosed pulmonary lymphangitis carcinomatosis. Sixteen days after the onset of respiratory symptoms, he died due to respiratory failure.