{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T07:01:45Z","timestamp":1790146905668,"version":"4.0.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary lymphangitic carcinomatosis (PLC) clinically and radiologically mimics interstitial lung disease (ILD), posing diagnostic challenges when the primary malignancy is occult.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 33-year-old male presented with progressive cough, dyspnea, and a rib fracture following minimal trauma. Chest CT showed bilateral interlobular septal thickening and mediastinal lymphadenopathy. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of subcarinal nodes confirmed metastatic adenocarcinoma, with immunohistochemistry (CK7+,TTF-1\u2212, Napsin A\u2212) suggesting gastrointestinal origin. Subsequent PET-CT and gastroscopy identified a 4.0\u2005cm gastric angulus tumor, biopsied as moderately to poorly differentiated adenocarcinoma with signet-ring cells. Despite first-line and second-line chemotherapy with transient improvement, rapid progression ensued. The patient died on February 18, 2025, with an overall survival of approximately 6 months from metastatic diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case illustrates that in young patients with ILD-like imaging and low-energy fractures, PLC warrants consideration even without gastrointestinal symptoms. Early use of EBUS-TBNA and PET-CT may facilitate timely diagnosis in appropriate clinical settings. Signet-ring cell-associated PLC carries a dismal prognosis, and transient responses should not be misconstrued as long-term benefit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1932110","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T06:19:45Z","timestamp":1790144385000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary lymphangitic carcinomatosis and pathological fracture as the initial manifestations of occult gastric adenocarcinoma mimicking interstitial lung disease: a case report and review of the literature"],"prefix":"10.3389","volume":"13","author":[{"given":"Yan-Feng","family":"Yan","sequence":"first","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital of Gansu University of Chinese Medicine (Lanzhou Petrochemical General Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Xia","family":"Qi","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Bone Diseases, Affiliated Hospital of Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie-Xiang","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Bone Diseases, Affiliated Hospital of Gansu University of Chinese Medicine","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cai-Hong","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital of Gansu University of Chinese Medicine (Lanzhou Petrochemical General Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Hui","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, The Fourth Affiliated Hospital of Gansu University of Chinese Medicine (Lanzhou Petrochemical General Hospital)","place":["Lanzhou, Gansu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.lungcan.2012.09.009","article-title":"Cutaneous lymphangitis carcinomatosa in a patient with lung adenocarcinoma: case report and literature review","volume":"79","author":"Prat","year":"2013","journal-title":"Lung Cancer"},{"key":"B2","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1016\/j.crad.2020.12.025","article-title":"Micronodular lung disease on high-resolution CT: patterns and differential 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