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Pulmonale Lymphangiosis carcinomatosa

Pulmonary lymphangiosis carcinomatosis

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Zusammenfassung

Lymphangiosis carcinomatosa bezeichnet eine diffuse Durchsetzung des pulmonalen Lymphgefäßsystems durch Tumorzellen, am häufigsten ist sie beim Mammakarzinom. Differenzialdiagnostisch ist sie abzugrenzen von u. a. einem „capillary-leak-syndrome“, einer pulmonalen Stauung nach Antracyclin-Therapie, einer radiogenen Pneumonitis, einer durch Immunsuppression bedingten atypischen Pneumonie und einer kardial bedingten Stauung. Trotz der sehr schlechten Spontanprognose ist ein therapeutischer Nihilismus keinesfalls gerechtfertigt. Neben der supportiven Therapie (Diuretika, Steroide, Theophyllin, Heparin, Analgetika) sollte eine tumorspezifische Behandlung nicht vernachlässigt werden, beispielsweise durch 5-FU (i.v., z. B. bei Mamma-, Magenkarzinom), Anthrazykline (nicht vorbehandeltes Mammakarzinom), Taxane und neue Zytostatika (Vinorelbin, Taxotere, Gemcitabin), Immuntherapeutika bzw. -modulatoren (Herceptin, Erlotinib). Im Falle sensibler Tumoren kommt der spezifischen hormonellen Therapie besondere Bedeutung zu.

Abstract

Pulmonary lymphangitis carcinomatosis is a diffuse infiltration of the pulmonary lymph vessel system by tumor cells and is most commonly associated with breast cancer. The main factors for differential diagnosis are capillary leak syndrome, pulmonary hypertension after anthracycline therapy, radiogenic pneumonitis, immunosuppression-linked atypical pneumonia and cardiac-linked hypertension. Despite the poor prognosis a therapeutic nihilism is totally unjustified. In addition to supportive therapy (diuretics, steroids, theophylline, heparin and analgesics) a tumor-specific treatment should not be neglected, for example with 5-FU (iv. for breast and stomach cancer), anthracycline (non-pretreated breast cancer), taxanes and new cytostatic drugs (vinorelbin, Taxotere, gemcitabin), immunotherapeutic agents or immunomodulators (Herceptin, erlotinib). In the case of sensitive tumors, a specific hormonal therapy is also extremely useful.

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Authors and Affiliations

  1. Klinik für Innere Medizin, Klinikum Duisburg, Zu den Rehwiesen 9, 47055, Duisburg, Deutschland

    E.M. Kirchner & S. Petrasch

  2. Institut für Diagnostische und Interventionelle Radiologie Klinikum Niederberg Velbert, Velbert, Deutschland

    J. Kirchner

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  1. E.M. Kirchner
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  2. J. Kirchner
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  3. S. Petrasch
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Correspondence to E.M. Kirchner.

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Kirchner, E., Kirchner, J. & Petrasch, S. Pulmonale Lymphangiosis carcinomatosa. Onkologe 13, 1131–1140 (2007). https://doi.org/10.1007/s00761-007-1285-x

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