scholarly journals Postmortem diagnosis of pulmonary tumor thrombotic microangiopathy with rapid exacerbation in a patient with gastric cancer: a case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ryo Kamidani ◽  
Keisuke Kumada ◽  
Hideshi Okada ◽  
Genki Yoshimura ◽  
Tomohiro Kanayama ◽  
...  

Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy. Case presentation A 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was admitted to the intensive care unit and was treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made. Conclusions In patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible.

2021 ◽  
Author(s):  
Ryo Kamidani ◽  
Keisuke Kumada ◽  
Hideshi Okada ◽  
Genki Yoshimura ◽  
Tomohiro Kanayama ◽  
...  

Abstract Background: Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition that involves the development of pulmonary hypertension due to the presence of microscopic tumor emboli of the peripheral pulmonary arteries. Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer that was identified postmortem through pathological autopsy.Case presentation: A 52-year-old Asian woman who experienced anterior chest pain while coughing visited the orthopedic department of the Gifu University Hospital. She was diagnosed as having multiple osteolytic bone metastases throughout her body and was subsequently scheduled to undergo combined positron emission tomography and computed tomography (CT) to search for a primary lesion. However, 4 days after her visit to the orthopedic department, she was unable to stand up and thus visited the emergency department. At the time of admission, physical examination results revealed that she had a percutaneous oxygen saturation level of 90% (on room air) and cyanosis, and that she was in a state of hemodynamic shock. Laboratory test results revealed elevated levels of fibrin degradation products and D-dimer in her blood. Chest CT results were normal. She was admitted to the hospital’s general ward for follow-up but soon entered a gradually worsening state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was admitted to the intensive care unit and was treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made. Conclusions: In patients with carcinoma of unknown primary site and pulmonary hypertension with pulmonary embolism ruled out by CT, emergency physicians and intensivists must consider the possibility of PTTM, which represents an oncologic emergency, and initiate chemotherapy administration as soon as possible.


2021 ◽  
Author(s):  
Ryo Kamidani ◽  
Keisuke Kumada ◽  
Hideshi Okada ◽  
Genki Yoshimura ◽  
Tomohiro Kanayama ◽  
...  

Abstract Background: Pulmonary tumor thrombotic microangiopathy (PTTM) is a condition involving the development of pulmonary hypertension caused by the presence of microscopic tumor emboli of peripheral pulmonary arteries . Here, we report a case of rapidly exacerbating PTTM associated with gastric cancer, which was identified after the patient’s death through a pathological autopsy.Case presentation: Four days before a 52-year-old Asian woman, whose initial symptom was the occurrence of anterior chest pain while coughing, visited the emergency department of Gifu University Hospital, she had been diagnosed as having multiple osteolytic bone metastases throughout her body; for the detection of a primary lesion, she was scheduled to undergo combined positron emission tomography and computed tomography (CT) at a later date. However, she was unable to stand up, and consequently, she visited the emergency department. At the time of admission, the results of a physical examination revealed that while breathing room air, she had a percutaneous oxygen saturation level of 90% and cyanosis, and she was in a state of hemodynamic shock; laboratory-test data revealed the presence of elevated levels of fibrin degradation products and D-dimer in her blood. The results of chest CT were normal. She was admitted to the hospital’s general ward for follow-up; however, she was soon in a further state of shock and respiratory failure. Electrocardiography revealed findings associated with right heart strain; however, contrast-enhanced CT did not reveal the presence of pulmonary embolism. She was transported to an intensive care unit of the hospital and treated for pulmonary hypertension; however, 45 h after her arrival at the hospital, she died of respiratory failure. A pathological autopsy revealed the presence of gastric cancer, tumor microemboli, and fibrous intimal thickening of the peripheral arteries of both lungs; thus, a diagnosis of PTTM was made. Conclusion: In cases involving patients with carcinoma of unknown primary site and pulmonary hypertension, if CT scan rules out pulmonary embolism, emergency physicians and intensivists must consider the possibility of the patients having PTTM, which represents an oncologic emergency, and initiate the administration of chemotherapy as soon as possible.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naoki Kawakami ◽  
Tomohiro Moriya ◽  
Rina Kato ◽  
Kentaro Nakamura ◽  
Hiroaki Saito ◽  
...  

Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported. Case presentation A previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer. Conclusions Despite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable.


2021 ◽  
Vol 3 (7) ◽  
pp. 1029-1031
Author(s):  
Benjamin P. Schwartz ◽  
Philip Tracy ◽  
Stephanie Hon ◽  
Harrison W. Farber ◽  
James E. Udelson

Haigan ◽  
2012 ◽  
Vol 52 (4) ◽  
pp. 420-425 ◽  
Author(s):  
Kiyokazu Yoshinoya ◽  
Yu Kasamatsu ◽  
Shougen Boku ◽  
Takashi Kida ◽  
Masatoshi Kadoya ◽  
...  

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096904
Author(s):  
Constanza Burciaga Calderoni ◽  
Dafne T Moretta ◽  
Jeanette Merrill-Henry ◽  
Paresh C Giri

Pulmonary tumor thrombotic microangiopathy is a rare condition in which embolization of tumor cells to the pulmonary arterioles causes fibrocellular intimal thickening and activation of the coagulation cascade resulting in pulmonary hypertension and right heart failure. Herein, we highlight a young 35-year-old male with no known past medical history who presented with recurrent syncope and dyspnea, and was found to have severe right heart failure and pulmonary hypertension. He developed sudden clinical deterioration and died after a cardiac arrest. Autopsy revealed poorly differentiated gastric adenocarcinoma and pulmonary tumor thrombotic microangiopathy. New onset severe pulmonary hypertension and right heart failure without any other obvious etiology should encourage the reader to evaluate for pulmonary tumor thrombotic microangiopathy and undergo a diligent search for underlying malignancy. This case highlights recurrent syncope as a rare presentation of this rapidly fatal disease.


2014 ◽  
Vol 14 (2) ◽  
pp. 142 ◽  
Author(s):  
Rohan Mandaliya ◽  
Salman Farhat ◽  
Dipesh Uprety ◽  
Mamtha Balla ◽  
Apurva Gandhi ◽  
...  

Sign in / Sign up

Export Citation Format

Share Document