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Gil-García CA, Cueto-Robledo G, Gonzalez-Hermosillo LM, Alfaro-Cruz A, Roldan-Valadez E. Nonthrombotic Pulmonary Embolism Associated With Non-Hodgkin Lymphoma. Curr Probl Cardiol 2023; 48:102001. [PMID: 37506958 DOI: 10.1016/j.cpcardiol.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Nonthrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography to novel biomarkers, enabling the accurate and timely identification of NTPE. NTPE treatment options are diverse and patient-specific, requiring customized approaches to address varying embolic sources. Anticoagulation, embolus removal, and emerging interventions under study are discussed, providing clinicians with a comprehensive understanding of management strategies. This article uncovers the rare but captivating association between NTPE and non-Hodgkin lymphoma. Although rare, documented cases have sparked curiosity among researchers and medical practitioners. We explore potential pathophysiological connections, discussing challenges and considerations when encountering this unique scenario. In conclusion, this captivating review encapsulates the multifaceted realm of NTPE, covering its classification, diagnostics, and treatment modalities. Moreover, it presents a fascinating connection with non-Hodgkin lymphoma. This article offers a comprehensive and concise review of NTPE, guiding readers through its intricate classification, diagnostic approaches, and therapeutic interventions.
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Affiliation(s)
- Cesar-Alejandro Gil-García
- Faculty of Medicine, Autonomous University of Sinaloa, Los Mochis, Sinaloa, México; Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Ana Alfaro-Cruz
- Department of Surgical Pathology, General Hospital of Mexico, "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico; Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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2
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Prevalence, Treatment, and Prognosis of Tumor Thrombi in Renal Cell Carcinoma. JACC: CARDIOONCOLOGY 2022; 4:522-531. [DOI: 10.1016/j.jaccao.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
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3
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CARREIRA M, LISBOA-GONÇALVES P, MATOS MI, FLORES L, CUNHA F, VON HAFE P. Relapsing uterine adenosarcoma presenting as pulmonary hypertension. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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4
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Shah AT, Bernardo RJ, Berry GJ, Kudelko K, Wakelee HA. Two Cases of Pulmonary Tumor Thrombotic Microangiopathy Associated with ROS1-Rearranged Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 22:e153-e156. [PMID: 33153897 DOI: 10.1016/j.cllc.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Arpeet T Shah
- Division of Oncology, Stanford University, Stanford, CA
| | - Roberto J Bernardo
- Division of Pulmonary, Allergy and Critical Care, Stanford University, Stanford, CA
| | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, CA
| | - Kristina Kudelko
- Division of Pulmonary, Allergy and Critical Care, Stanford University, Stanford, CA
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5
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Lovrenski A, Vrekić Ž, Škrbić D, Višnjić BA, Vasilijević M, More LV. An autopsy case of massive pulmonary tumor embolism due to undiagnosed prostatic adenocarcinoma. Forensic Sci Med Pathol 2019; 16:152-156. [PMID: 31691070 DOI: 10.1007/s12024-019-00184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2019] [Indexed: 12/31/2022]
Abstract
Adenocarcinoma of the prostate is occasionally associated with pulmonary embolism, occurring as a result of secondary hypercoagulable states or cancer-associated emboli. The objective of this study was to provide a review of clinical, histopathological and immunohistochemical features of poorly differentiated prostatic adenocarcinoma, emphasizing the relevance of undiagnosed malignancy as a cause of pulmonary embolism. The current study describes the case of a 78-year-old male who experienced remarkable clinical symptoms suggestive of pulmonary embolism. Following several diagnostic examinations, the patient was diagnosed with pulmonary embolism, which led to the detection of prostatic adenocarcinoma. Poorly differentiated adenocarcinoma with a Gleason's score of nine was set as a definite diagnosis. Multiple tumor emboli within small and medium-sized pulmonary blood vessels were found in all specimens taken from lung tissue. Immunohistochemical analysis showed diffuse and strong positivity of tumor cells within pulmonary arteries. Hidden malignancy is a diagnostic challenge that should be considered in the differential diagnosis of pulmonary embolism. Laboratory and radiological findings with additional histopathological evaluation are needed for the definite diagnosis.
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Affiliation(s)
| | - Željka Vrekić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dušan Škrbić
- Institute For Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
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6
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Gioia MR, Maccari U, Marchetti L, Maglioni E, Ciarleglio G, Granese V, Salerno L, Spagnoli L, Zanellato I, Ambrosio MR, Bianco A, Scala R. Occult malignancy underlying a case of "hyperacute" onset of severe pulmonary hypertension. ERJ Open Res 2019; 5:00157-2019. [PMID: 31637250 PMCID: PMC6791963 DOI: 10.1183/23120541.00157-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/03/2019] [Indexed: 11/07/2022] Open
Abstract
“Tumoral pulmonary hypertension (PH)” includes several subtypes of conditions leading to abnormal levels of pulmonary artery or venous pressure occurring in patients with a current or previous malignancy. Pulmonary tumour “microvascular disease” includes both pulmonary tumour microembolism (PTE) and pulmonary tumour thrombotic microangiopathy (PTTM) that are likely to be part of the same spectrum disease [1]. PTE was described in early studies, and was defined as the occlusion of the pulmonary microvasculature by tumour cells and associated thrombi. Tumour thrombi are frequently formed by malignant cells, platelets and fibrin, and are highly resistant to recanalisation and lead to an irreversible obstruction. In many cases, they are associated with vascular tissue reaction characterised by extensive fibrocellular intimal hyperplasia of small pulmonary arteries initiated by tumour microemboli known as PTTM [1, 2]. Most reported cases of PTE occur in association with adenocarcinomas, including liver [3, 4], kidney, breast [5, 6], stomach [4, 7], bladder and choriocarcinoma [8]. In a handful of cases of PTE, estimated at 5% [9], the primary cancer is unknown. Ante mortem diagnosis of PTE is often challenging and the majorities of cases are identified as results of post mortem studies. This is especially true for a subset of patients with occult malignancy and acute onset of severe PH. Investigations in a patient with new-onset pulmonary hypertension should include screening for undiagnosed malignancyhttp://bit.ly/2mrLmGM
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Affiliation(s)
| | - Uberto Maccari
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Luca Marchetti
- Anaesthesiology and Cardio-thoracic Intensive Care Unit "Le Scotte" Siena, Siena, Italy
| | - Enivarco Maglioni
- Anaesthesiology and Cardio-thoracic Intensive Care Unit "Le Scotte" Siena, Siena, Italy
| | | | - Valentina Granese
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Laura Salerno
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Luigi Spagnoli
- Dept of Medical Biotechnology, University of Siena, Siena, Italy
| | - Ilenia Zanellato
- Dept of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Andrea Bianco
- Dept of Translational Medical Sciences, Monaldi Hospital, Naples, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
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7
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Kirsch D, Scordi-Bello I. Fatal Microscopic Pulmonary Tumor Thromboemboli: Unusual Presentation of Occult Cervical Carcinoma. Two Case Reports and Review of the Literature. Acad Forensic Pathol 2019; 9:81-92. [PMID: 34394793 DOI: 10.1177/1925362119851131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/15/2022]
Abstract
Cor pulmonale (right heart failure) due to microscopic pulmonary tumor emboli (MPTE) can arise from a variety of malignancies including breast, lung, and liver and carries significant morbidity and mortality. Tumor cell aggregates spread hematogenously to the lungs and occlude small pulmonary vessels leading to pulmonary hypertension through either a mechanical process or inducing vascular remodeling as a downstream result of interactions between the embolus and the vessel wall. Its presentation includes unexplained dyspnea, hypoxemia, tachycardia, pulmonary hypertension, right heart failure, and in some cases sudden death. The symptoms may suggest the more common entity of pulmonary thromboembolism, particularly in the setting of previously known metastatic cancer; however, computed tomography scans may appear normal and ventilation-perfusion scans which are the preferable diagnostic modality are not always ordered. In most cases of MPTE, the presentation reflects metastasis of an already known and advanced tumor, but, in rare cases, it may be the primary manifestation of an occult malignancy. We present here 2 unique cases of MPTE in women with occult cervical cancer. In both cases, the malignancy was discovered and diagnosed at autopsy. Microscopic pulmonary tumor emboli can be easily overlooked, and therefore, forensic pathologists and other death investigators should be aware of it and trained to at least consider the possibility in appropriate situations. Thorough microscopic examination of apparently normal tissues may be necessary, particularly in cases of unexplained right heart failure and sudden death, even if the decedent has few or no identifiable risk factors for cancer.
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8
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Price LC, Seckl MJ, Dorfmüller P, Wort SJ. Tumoral pulmonary hypertension. Eur Respir Rev 2019; 28:28/151/180065. [DOI: 10.1183/16000617.0065-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/23/2018] [Indexed: 12/15/2022] Open
Abstract
Tumoral pulmonary hypertension (PH) comprises a variety of subtypes in patients with a current or previous malignancy. Tumoral PH principally includes the tumour-related pulmonary microvascular conditions pulmonary tumour microembolism and pulmonary tumour thrombotic microangiopathy. These inter-related conditions are frequently found inpost mortemspecimens but are notoriously difficult to diagnoseante mortem. The outlook for patients remains extremely poor although there is some emerging evidence that pulmonary vasodilators and anti-inflammatory approaches may improve survival. Tumoral PH also includes pulmonary macroembolism and tumours that involve the proximal pulmonary vasculature, such as angiosarcoma; both may mimic pulmonary embolism and chronic thromboembolic PH. Finally, tumoral PH may develop in response to treatments of an underlying malignancy. There is increasing interest in pulmonary arterial hypertension induced by tyrosine kinase inhibitors, such as dasatanib. In addition, radiotherapy and chemotherapeutic agents such as mitomycin-C can cause pulmonary veno-occlusive disease. Tumoral PH should be considered in any patient presenting with unexplained PH, especially if it is poorly responsive to standard approaches or there is a history of malignancy. This article will describe subtypes of tumoral PH, their pathophysiology, investigation and management options in turn.
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9
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Okazaki S, Abe T, Takayanagi N, Yasuda M, Sakai F, Kobayashi K, Kato S. Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report. ACTA ACUST UNITED AC 2018; 32:337-343. [PMID: 29475918 DOI: 10.21873/invivo.11243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM We report on a case of pulmonary tumor embolism caused by squamous cell carcinoma of the uterine cervix. PATIENTS AND METHODS A 60-year-old female diagnosed with stage IVB (cT4N1M1) squamous cell carcinoma of the uterine cervix was admitted to our institution with a chief complaint of progressive dyspnea that developed within a few days after admission. RESULTS A chest CT scan showed dilated pulmonary arteries, right ventricular enlargement and mosaic ground-glass opacities in both lungs. An echocardiogram revealed elevated right ventricular pressure and a floppy mass in the right ventricle. Pulmonary tumor embolism was highly suspected. However, she died from respiratory failure on the fourth day after admission. Autopsy revealed diffuse tumor emboli in bilateral pulmonary arteries and arterioles. CONCLUSION Pulmonary tumor embolism should be considered when patients with malignant disease develop unexplained dyspnea, hypoxemia, and pulmonary hypertension.
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Affiliation(s)
- Shohei Okazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
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10
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Bois MC, Eckhardt MD, Cracolici VM, Loe MJ, Ocel JJ, Edwards WD, McBane RD, Bower TC, Maleszewski JJ. Neoplastic embolization to systemic and pulmonary arteries. J Vasc Surg 2018; 68:204-212.e7. [PMID: 29502997 DOI: 10.1016/j.jvs.2017.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/23/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens. METHODS Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016). RESULTS Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%. CONCLUSIONS This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.
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Affiliation(s)
- Melanie C Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Michael D Eckhardt
- Department of Pathology and Laboratory Medicine, University of Chicago, NorthShore University HealthSystem, Evanston, Ill
| | | | - Matthew J Loe
- Interventional Radiology, St. Paul Radiology, St. Paul, Minn
| | - Joseph J Ocel
- Diagnostic Radiology, Mercy Health Services-Iowa Corporation, Mason City, Iowa
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Robert D McBane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
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11
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Morin-Thibault LV, Wiseman D, Fortin M, Couture C, Provencher S. Pulmonary micro-tumor emboli resulting in paradoxical emboli: a case report. Pulm Circ 2018; 8:2045893218754853. [PMID: 29308711 PMCID: PMC5826013 DOI: 10.1177/2045893218754853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pulmonary tumor embolism (PTE) is a rare manifestation of cancer. It is characterized by the presence of tumor cell emboli in the pulmonary arterioles and capillaries leading to an elevation of pulmonary vascular resistance. The ante-mortem diagnosis is difficult. We report a case of PTE associated with recurrent breast cancer that presented with neurological symptoms due to paradoxical cerebral embolism.
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Affiliation(s)
- Louis-Vincent Morin-Thibault
- 1 Pulmonary Hypertension Research Group ( http://www.hypertensionarteriellepulmonaire.ca ).,2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Daniel Wiseman
- 2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Michelle Fortin
- 2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Christian Couture
- 2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Steeve Provencher
- 1 Pulmonary Hypertension Research Group ( http://www.hypertensionarteriellepulmonaire.ca ).,2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada.,3 Department of Medicine, Université Laval, Québec City, QC, Canada
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12
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Merad M, Alibay A, Ammari S, Antoun S, Bouguerba A, Ayed S, Vincent F. [Pulmonary tumor thrombotic microangiopathy]. Rev Mal Respir 2017; 34:1045-1057. [PMID: 29153757 DOI: 10.1016/j.rmr.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/08/2017] [Indexed: 12/25/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.
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Affiliation(s)
- M Merad
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - A Alibay
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - S Ammari
- Service de radiologie, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - S Antoun
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - A Bouguerba
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France
| | - S Ayed
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France
| | - F Vincent
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France.
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13
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Mainardi AS, Trow T. Tumor Emboli: A Rare Cause of Acute Pulmonary Hypertension. Am J Med 2017; 130:e137-e139. [PMID: 28159185 DOI: 10.1016/j.amjmed.2016.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Anne S Mainardi
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
| | - Terence Trow
- Pulmonary, Critical Care, and Sleep Medicine Section, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
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14
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Extracorporeal Lung Support as a Bridge to Diagnosis of Pulmonary Tumor Embolism. Case Rep Pulmonol 2017; 2016:3257084. [PMID: 28070437 PMCID: PMC5192304 DOI: 10.1155/2016/3257084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 11/24/2016] [Indexed: 11/29/2022] Open
Abstract
Bridging to diagnosis is an emerging technique used in end-stage cardiorespiratory failure that prolongs a patient's life using various modalities of extracorporeal lung support (ECLS) to achieve antemortem diagnosis. Pulmonary tumor embolism occurs when cell clusters travel from primary malignancies through venous circulation to the lungs, causing respiratory failure through inflammatory and venoocclusive pathways. Due to its nonspecific symptomatology, pulmonary tumor embolism remains an elusive diagnosis antemortem. Herein, we bridge a patient who presented in acute respiratory failure to the diagnosis of pulmonary tumor embolism from a gastric signet-ring cell carcinoma using ECLS modalities including venoarterial extracorporeal membrane oxygenation and centrally cannulated Novalung pumpless extracorporeal lung assist. We demonstrate the utility of this approach in diagnostically uncertain cases in unstable patients who are potentially acceptable ECLS and transplant candidates.
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15
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Srettabunjong S, Chuangsuwanich T. Inferior Vena Cava Tumor Thrombosis Secondary to Metastatic Uterine Cancer: A Rare Cause of Sudden Unexpected Death. J Forensic Sci 2016; 61:555-558. [PMID: 27404631 DOI: 10.1111/1556-4029.13032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/08/2015] [Indexed: 11/30/2022]
Abstract
Pulmonary tumor thromboembolus (PTTE) secondary to uterine cancer is a rare cause of sudden unexpected deaths in the elderly population. Additionally, tumor extension to the inferior vena cava (IVC) makes it rarer. No such cases have been previously reported in the forensic literature. We report this phenomenon in a previously healthy 70-year-old woman with no other known risk factors for the development of deep vein thrombosis. The deceased was found dead while watching television with her relatives. Autopsy examination revealed that her death was attributed to a saddle embolus lodged in the main pulmonary arteries. A uterine tumor was discovered, and microscopic examination revealed low-grade endometrial stromal sarcoma with angiolymphatic invasion. The tumor cells were also found in the embolus and the remnant thrombosis attached to the inner wall of the IVC. This case demonstrates a sudden unexpected death caused by acute PTTE following seeding of uterine cancer into the IVC and raises awareness of such events.
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Affiliation(s)
- Supawon Srettabunjong
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Tuenjai Chuangsuwanich
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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16
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Mury C, Schneider AG, Nobile A, Rotman S, Liaudet L. Acute pulmonary hypertension caused by tumor embolism: a report of two cases. Pulm Circ 2015; 5:577-9. [PMID: 26401259 DOI: 10.1086/682225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/04/2015] [Indexed: 11/04/2022] Open
Abstract
Acute pulmonary hypertension leading to right ventricular failure and circulatory collapse is usually caused by thromboembolic obstruction of the pulmonary circulation. However, in rare instances, other causes can be associated with a similar clinical presentation. We present and discuss the clinical histories of two patients with acute right ventricular failure due to an atypical cause of pulmonary hypertension, disseminated pulmonary tumor embolism.
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Affiliation(s)
- Caroline Mury
- Department of Intensive Care and Burn Center, University Hospital Medical Center and Faculty of Biology and Medicine, Lausanne 1011, Switzerland ; These authors contributed equally to this work
| | - Antoine G Schneider
- Department of Intensive Care and Burn Center, University Hospital Medical Center and Faculty of Biology and Medicine, Lausanne 1011, Switzerland ; These authors contributed equally to this work
| | - Antoine Nobile
- Department of Clinical Pathology, University Hospital Medical Center and Faculty of Biology and Medicine, Lausanne 1011, Switzerland
| | - Samuel Rotman
- Department of Clinical Pathology, University Hospital Medical Center and Faculty of Biology and Medicine, Lausanne 1011, Switzerland
| | - Lucas Liaudet
- Department of Intensive Care and Burn Center, University Hospital Medical Center and Faculty of Biology and Medicine, Lausanne 1011, Switzerland
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17
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Purga SL, Narula N, Horn EM, Karas MG. Pulmonary tumour thrombotic microangiopathy as a cause of new-onset pulmonary hypertension in a patient with metastatic low-grade serous ovarian cancer. BMJ Case Rep 2015; 2015:bcr-2015-211890. [PMID: 26311016 DOI: 10.1136/bcr-2015-211890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 78-year-old woman with metastatic low-grade serous ovarian cancer presented with rapidly progressive exertional dyspnoea and hypoxia, and was found to have new-onset severe pulmonary hypertension (PH) by right heart catheterisation. A diagnosis of pulmonary tumour thrombotic microangiopathy (PTTM) was made at autopsy. PTTM is a rare complication of advanced cancer that often presents as rapidly progressive PH or acute hypoxic respiratory failure. Widespread tumour cell emboli in the pulmonary arteries and arterioles are hypothesised to induce fibrocellular subintimal proliferation and microthrombi, leading to increased pulmonary vascular resistance and PH. PTTM arising from serous ovarian cancer is exceedingly rare, with only two previously reported cases. A discussion of the pathophysiology, diagnosis and management of PTTM is presented.
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Affiliation(s)
- Scott L Purga
- Department of Internal Medicine, NYP/Weill Cornell Medical College, New York, New York, USA
| | - Navneet Narula
- Department of Pathology, Weill Cornell Medical College, New York, New York, USA
| | - Evelyn M Horn
- Department of Cardiology, Weill Cornell Medical College, New York, New York, USA
| | - Maria G Karas
- Department of Cardiology, Weill Cornell Medical College, New York, New York, USA
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18
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Fatal Pulmonary Tumor Embolic Microangiopathy in Young Lady without Known Primary Malignancy. Case Rep Crit Care 2014; 2014:231081. [PMID: 25478243 PMCID: PMC4247920 DOI: 10.1155/2014/231081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 10/23/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022] Open
Abstract
Pulmonary embolism (PE) is a common cause of morbidity and mortality in hospitalized patients. Malignancy, prolonged recumbence, and chemotherapy are renowned risk factors for development of clinically significant PE. Cancer exerts a multitude of pathophysiological processes, for example, hypercoagulability and abnormal vessels with sluggish circulation that can lead to PE. One of the peculiar characteristics of tumor cells is their ability to reach the circulation and behave as blood clot-not a metastasis-occluding the pulmonary circulation. We present a case of fatal pulmonary embolism diagnosed histologically to be due to tumor cell embolism.
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19
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Saddle pulmonary tumor embolus secondary to renal cell carcinoma. JAAPA 2013; 26:37-9. [PMID: 24153090 DOI: 10.1097/01.jaa.0000436685.90928.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most pulmonary tumor emboli are microscopic and occlude small arteries and arterioles with subsequent insidious clinical presentation. These emboli usually need conservative treatment. Emboli that spread to large proximal pulmonary arteries, although rare, can be life-threatening. This article focuses on the importance of prompt recognition, diagnosis, and appropriate management of pulmonary tumor emboli.
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20
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Abstract
World Health Organization (WHO) group 5 pulmonary hypertension (PH) entails a heterogeneous group of disorders that may cause PH by unclear and/or multiple mechanisms. In particular, group 5 includes PH caused by hematologic disorders, systemic diseases, metabolic disorders, chronic renal failure, and disorders leading to pulmonary vascular occlusion or compression. This article discusses common pathogenic mechanisms leading to group 5 PH, followed by a detailed overview of epidemiology, pathogenesis, and disease-specific management of the individual group 5 conditions. Off-label use of vasomodulatory therapies, typically indicated for pulmonary arterial hypertension (WHO group 1 PH), in group 5 conditions is also discussed.
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Affiliation(s)
- Tim Lahm
- Division of Pulmonary, Allergy, Critical Care, Occupational and Sleep Medicine, Department of Medicine, Richard L. Roudebush VA Medical Center, Center for Immunobiology, Indiana University School of Medicine, 980 West Walnut Street, Room C400, Indianapolis, IN 46202, USA.
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21
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Yang Y, Choi Y, Beom SH, Kim JW, Joen YK, Kim NJ, Kim JH, Im SA, Lee KH. A case report of breast cancer with extensive pulmonary lymphovascular tumor emboli. J Breast Cancer 2012; 15:128-32. [PMID: 22493640 PMCID: PMC3318165 DOI: 10.4048/jbc.2012.15.1.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/10/2011] [Indexed: 11/30/2022] Open
Abstract
We describe a patient with breast cancer who relapsed with an extensive pulmonary lymphovascular tumor embolism. A 38-year-old female, who previously received neoadjuvant chemotherapy and curative resection of breast cancer, underwent adjuvant chemotherapy and was referred to the emergency room because of sudden-onset pleuritic chest pain lasting for 10 days. Despite a trial of empirical antibiotics, the chest pain and the extent of consolidative lung lesion on chest radiographs rapidly aggravated. We performed an open lung biopsy to confirm the etiology. The histopathological review revealed a hemorrhagic infarction caused by lymphovascular tumor emboli from a metastatic breast carcinoma. Palliative first-line chemotherapy was administered, consisting of ixabepilone and capecitabine, and the lung lesion improved markedly.
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Affiliation(s)
- Yaewon Yang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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22
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Picone CE, Fleury TA. A 74-year-old woman with subacute dyspnea, profound hypoxemia, normal lung images, and refractory cardiopulmonary collapse. Chest 2012; 141:1106-1109. [PMID: 22474154 DOI: 10.1378/chest.11-1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Carlos E Picone
- Department of Internal Medicine, Sibley Memorial Hospital, Washington, DC.
| | - Thomas A Fleury
- Department of Pathology, Sibley Memorial Hospital, Washington, DC
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23
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Lammi M, Wurzel J, Criner GJ. Pulmonary tumor embolism. Lung 2010; 188:441-3. [PMID: 20607269 DOI: 10.1007/s00408-010-9249-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 06/18/2010] [Indexed: 10/19/2022]
Abstract
A 36-year-old woman with breast cancer was admitted with shortness of breath. A computed tomography angiogram was obtained and was negative for pulmonary embolism. She quickly developed hypoxemic respiratory failure and was transferred to the intensive care unit. She appeared to be improving when she suffered sudden cardiac death. Autopsy showed extensive lymphatic and vascular tumor emboli, which were the immediate cause of death. Tumor emboli are rarely diagnosed before death but seem to be more common than realized. It is important to recognize this entity, because there have been some case reports of cure. The usual mechanism of death is progressive right heart failure; sudden death from tumor embolism has rarely been described.
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Affiliation(s)
- Matthew Lammi
- Division of Pulmonary and Critical Care Medicine, Temple University Hospital, 3401 N. Broad Street, 7th Floor Parkinson Pavilion, Philadelphia, PA 19140, USA.
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24
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Miyoshi S, Hamada H, Katayama H, Hamaguchi N, Kadowaki T, Ito R, Irifune K, Miyazaki T, Higaki J. Pulmonary tumor thrombotic microangiopathy associated with lung cancer. J Cardiol Cases 2010; 1:e120-e123. [DOI: 10.1016/j.jccase.2009.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/15/2009] [Accepted: 10/22/2009] [Indexed: 11/29/2022] Open
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25
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Tsoi DT, Rowsell C, McGregor C, Kelly CM, Verma S, Pritchard KI. Disseminated tumor embolism from breast cancer leading to multiorgan failure. J Clin Oncol 2010; 28:e180-3. [PMID: 20124175 DOI: 10.1200/jco.2009.25.1009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daphne T Tsoi
- Division of Medical Oncology, Sunnybrook Odette Cancer Centre, The University of Toronto, Toronto, Ontario, Canada
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26
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Dalal PU. Non-metastatic manifestations of cancer in the chest. IMAGING 2008. [DOI: 10.1259/imaging/83642253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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27
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Shao L, Willard MJ, Lowe LH, Singh V. Fatal pulmonary tumor embolism in a child with chondroblastic osteosarcoma. Pediatr Dev Pathol 2008; 11:156-9. [PMID: 17990913 DOI: 10.2350/07-02-0241.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 06/05/2007] [Indexed: 11/20/2022]
Abstract
Fatal embolic chondroblastic osteosarcoma to the lung is an extremely rare phenomenon. We report a case of a 15-year-old boy who developed bilateral pulmonary embolism shortly after resection of the right distal femur for chondroblastic osteosarcoma. The patient succumbed to right-sided heart failure 8 weeks later. An autopsy revealed extensive intravascular tumor emboli in the bilateral pulmonary arteries and their branches. No metastatic lesions were identified in the lungs. We review the clinical, radiologic, and pathologic findings of this patient and the literature.
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Affiliation(s)
- Lei Shao
- Department of Pathology, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64104, USA.
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28
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Korte W. Cancer and thrombosis: an increasingly important association. Support Care Cancer 2008; 16:223-8. [PMID: 18197438 DOI: 10.1007/s00520-007-0376-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 12/06/2007] [Indexed: 01/20/2023]
Affiliation(s)
- Wolfgang Korte
- Institut für Klinische Chemie und Hämatologie, Kantonsspital, St Gallen, Switzerland.
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29
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McDonald DK, Kalva SP, Fan CM, Vasilyev A. Leiomyosarcoma of the uterus with intravascular tumor extension and pulmonary tumor embolism. Cardiovasc Intervent Radiol 2007; 30:140-2. [PMID: 17031731 DOI: 10.1007/s00270-006-0118-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report the case of a 48-year-old woman presenting with recurrent uterine leiomyosarcoma (LMS) associated with right iliac vein and inferior vena cava (IVC) invasion and left lower lobe pulmonary tumor embolus. Because the prognosis and treatment differ from that of thrombotic pulmonary emboli, the differentiating imaging characteristics of intravascular tumor embolism are reviewed. To our knowledge, only two other cases of intravenous uterine leiomyosarcomatosis have been described in the existing literature, and this is the first reported case of the entity with associated intravascular tumor embolism.
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Affiliation(s)
- Douglas K McDonald
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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30
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Dot JM, Sztrymf B, Yaïci A, Dorfmüller P, Capron F, Parent F, Jaïs X, Sitbon O, Simonneau G, Humbert M. Hypertension artérielle pulmonaire postembolique tumorale. Rev Mal Respir 2007; 24:359-66. [PMID: 17417176 DOI: 10.1016/s0761-8425(07)91070-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is rare in the presence of malignancy and tumour embolisation is one of several possible pathological mechanisms. CASE REPORTS We report our experience of 5 clinical cases and undertake a literature revue of the pathophysiological mechanisms and of the possible diagnostic and therapeutic approaches. CONCLUSIONS Neoplastic PAH due to tumour micro-emboli is rare and the diagnosis difficult to establish. Cytological examination of pulmonary arterial blood could allow early institution of appropriate chemotherapy and lead to an improvement in the grave prognosis of this condition.
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Affiliation(s)
- J M Dot
- Centre national de référence de l'hypertension pulmonaire, UPRES EA 2705, service de pneumologie et réanimation respiratoire, Hôpital Antoine Béclère, Assistance publique-hôpitaux de Paris, université Paris Sud, Clamart, France
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31
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Deeren D, Verbeken E, Vanderschueren S, Wilmer A, Bobbaers H, Meersseman W. Cancer presenting as fatal pulmonary tumour embolism. Acta Clin Belg 2006; 61:30-4. [PMID: 16673614 DOI: 10.1179/acb.2006.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Rapidly fatal pulmonary tumour embolism is a rare complication of malignancy, and often presents as progressive dyspnea without obvious cause. We describe two cases presenting with a dramatic clinical picture of lactic acidosis and cardiopulmonary arrest soon after admission on ICU. The first patient was a 29-year old woman with a breast cancer seeming in remission who was admitted with rapidly increasing dyspnea since two weeks. The second patient was a 46-year old woman with HIV and no history of malignancy, who developed dyspnea and lactic acidosis over the course of a few days while she was investigated for an occipital brain lesion. Both patients died soon after admission and massive tumour emboli were found on autopsy. Breast cancer was the origin of the emboli in both cases. Symptoms were out of proportion to the initial physical cardiopulmonary findings and radiographic features. Clinical signs of pulmonary tumour embolism are non-specific and subacute. Prognosis is poor and definite diagnosis is usually made post-mortem. Solid malignancies such as breast cancer account for most of the cases. Pulmonary tumour embolism should be considered in critically ill patients with unexplained hypoxemia and lactic acidosis, mild or no radiological abnormalities and fast clinical deterioration. It may occur in young patients and in patients without history of malignancy.
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Affiliation(s)
- D Deeren
- Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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32
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Chi CL, Liu KL, Yuan A, Lien WC, Chen WJ, Wang HP. Pulmonary tumor embolism--diagnosis in the ED. Am J Emerg Med 2005; 23:808-10. [PMID: 16182993 DOI: 10.1016/j.ajem.2005.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2005] [Accepted: 03/05/2005] [Indexed: 01/22/2023] Open
Affiliation(s)
- Chun-Lin Chi
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
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33
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Papp E, Keszthelyi Z, Kalmar NK, Papp L, Weninger C, Tornoczky T, Kalman E, Toth K, Habon T. Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: A case report. World J Gastroenterol 2005; 11:2357-9. [PMID: 15818754 PMCID: PMC4305827 DOI: 10.3748/wjg.v11.i15.2357] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in pos-sible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocar-diography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.
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Affiliation(s)
- Elod Papp
- 1st Department of Medicine, University of Pecs Medical School, H-7624 Pecs, Ifjusag u. 13, Hungary.
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34
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Grass H, Schuff A, Staak M, Dienes HR, von Both I. Tumor embolism as a cause of an unexpected death: a case report. Pathol Res Pract 2004; 199:349-52. [PMID: 12908527 DOI: 10.1078/0344-0338-00429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The primary causes of deaths for individuals with rare cancers can be difficult to diagnose clinically. Often, the symptoms implicate a variety of factors, and an autopsy is thus required to obtain the correct diagnosis. This study analyzes the death of a 45-year-old woman who reportedly died from an acute pulmonary dysfunction. The patient had been treated with antibiotics for three months for intractable pneumonia. Suspicious coin lesions detected by chest X-ray prompted a clinical clarification; however, no final diagnosis was made. The autopsy revealed a bulky thyroid tumor with venous invasion, leading to a massive pulmonary tumor embolism. Furthermore, microscopy identified the tumor as a rare pleomorphic myxoid sarcoma. Thus, the patient died of a large pulmonary tumor embolism originating from this rare sarcoma, and not of acute pulmonary dysfunction of any other means.
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Affiliation(s)
- Hildegard Grass
- Institute of Legal Medicine, University of Cologne, Germany.
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35
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Felekis VA. The radiographic diagnostic value of low intensity reduction of the lung compliance in malignant neoplasms. Med Hypotheses 2003; 60:560-6. [PMID: 12615523 DOI: 10.1016/s0306-9877(03)00023-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The evaluation of low-intensity reduction in the compliance of the lung parenchyma (LIRCLP) can, we believe, give early diagnostic signs from a few months to two or more years before the time at which diagnosis can be made today from chest radiograms or CT scan of the chest in a significant number of cases of secondary lung neoplasm. Moreover, it can provide valuable information on small improvements or deteriorations in the great majority of patients with malignant neoplasms of the lung during the course of the illness. In general, the evaluation of LIRCLP improves the diagnostic capabilities not only of chest radiograms but also to some degree of CT scans of the chest. We consider that, apart from malignant neoplasms of the lung, it may also be of use in a large number of pathological conditions of the lung. We propose that the term hypoatelectasis be used for LIRCLP.
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Affiliation(s)
- Vasilios A Felekis
- Department of Radiology, Aghios Savvas Oncology Hospital, Athens, Greece.
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36
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Tucakovic M, Bascom R, Bascom PB. Pulmonary medicine and palliative care. Best Pract Res Clin Obstet Gynaecol 2001; 15:291-304. [PMID: 11358403 DOI: 10.1053/beog.2000.0169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.
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Affiliation(s)
- M Tucakovic
- Pulmonary, Allergy and Critical Care Medicine, the Department of Medicine, Penn State College of Medicine, The Milton S. Hershey Medical Center, Hershey, PA, USA
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37
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Tack D, Nollevaux MC, Gevenois PA. Tree-in-Bud Pattern in Neoplastic Pulmonary Emboli. AJR Am J Roentgenol 2001; 176:1421-2. [PMID: 11373205 DOI: 10.2214/ajr.176.6.1761421] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Tack
- Department of Radiology, Centre Hospitalier Universitaire de Charleroi, 92 Blvd. Janson, B-6000 Charleroi, Belgium
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38
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Chan GS, Ng WK, Ng IO, Dickens P. Sudden death from massive pulmonary tumor embolism due to hepatocellular carcinoma. Forensic Sci Int 2000; 108:215-21. [PMID: 10737468 DOI: 10.1016/s0379-0738(99)00212-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Massive pulmonary embolism in cancer patients can be due to detached thrombi or tumor. Pulmonary tumor embolism is often undiagnosed antemortem. We report a 52-year-old Chinese man admitted for management of hepatocellular carcinoma (HCC). Computerized tomography showed tumor involvement of hepatic vein and inferior vena cava. He died suddenly on the day of admission. At autopsy the main pulmonary arteries of both lungs were blocked by large tumor emboli, the immediate cause of death. Although rapid death in patients with HCC is usually caused by intraperitoneal hemorrhage from spontaneous rupture of tumor, massive pulmonary tumor embolism should also be considered in these patients, especially when antemortem evidence of hepatic vein and/or inferior vena cava invasion is present.
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Affiliation(s)
- G S Chan
- Department of Pathology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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39
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Montero A, Vidaller A, Mitjavila F, Chivite D, Pujol R. Microscopic pulmonary tumoral embolism and subacute cor pulmonale as the first clinical signs of cancer. Acta Oncol 2000; 38:1116-8. [PMID: 10665773 DOI: 10.1080/028418699432464] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Montero
- Internal Medicine Service, Hospital of Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Spain.
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40
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Ahmed AA, Heller DS. Fatal pulmonary tumor embolism caused by chondroblastic osteosarcoma: report of a case and review of the literature. Arch Pathol Lab Med 1999; 123:437-40. [PMID: 10235505 DOI: 10.5858/1999-123-0437-fptecb] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fatal pulmonary tumor embolism is an unusual phenomenon that has only rarely been reported with osteosarcoma. It usually presents with typical symptoms and signs of pulmonary thromboembolism. The authors report the case of a 65-year-old woman with chondroblastic osteosarcoma of the distal femur who suffered a fatal tumor embolism 30 hours after surgery and review the literature.
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Affiliation(s)
- A A Ahmed
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, USA
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41
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Bahammam A. Cardiac angiosarcoma presenting as right heart failure secondary to pulmonary vascular carcinomatosis. Ann Saudi Med 1999; 19:42-4. [PMID: 17337985 DOI: 10.5144/0256-4947.1999.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Bahammam
- Department of Medicine, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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42
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Ando H, Ootake Y, Asaka S. Subacute pulmonary hypertension due to pulmonary tumor microembolism as a clinical manifestation of occult gallbladder adenocarcinoma. JAPANESE CIRCULATION JOURNAL 1997; 61:82-6. [PMID: 9070964 DOI: 10.1253/jcj.61.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We report a 67-year-old man who developed pulmonary hypertension as an initial clinical manifestation of occult gallbladder adenocarcinoma. He had a 6-week history of persistent dry cough followed by progressive dyspnea on exertion. Physical examination and chest roentgenogram revealed signs of precapillary pulmonary hypertension. He died of shock 1 h after pulmonary angiography, which failed to show any intravascular filling defects. Autopsy disclosed a mucin-producing small adenocarcinoma (2 cm diameter) and a gallstone in the gallbladder with a few small metastases to peri-aortic, peri-bronchial and mediastinal lymph nodes. Macroscopically, there was no gross thrombotic pulmonary embolism or pulmonary metastases. However, microscopically, more than 60% of the small pulmonary arteries less than 1 mm in diameter were occluded with pulmonary tumor microemboli. This case emphasizes the need to include tumor pulmonary embolism in the differential diagnosis of pulmonary hypertension whether or not there is evidence of an underlying malignant tumor.
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Affiliation(s)
- H Ando
- Department of Internal Medicine, Takatsuki Red Cross Hospital, Osaka, Japan
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43
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Abstract
BACKGROUND Unexplained thromboembolism may be an early indicator of the presence of a malignant tumor before signs and symptoms of the tumor itself become obvious. METHODS A survey of the MEDLINE data-base was conducted concerning cancer-associated vascular disorders and their role in the diagnosis of hidden cancer. The spectrum of vascular disorders heralding occult cancer and the associated laboratory abnormalities were scrutinized. RESULTS Deep venous thrombosis was associated with a significantly higher frequency of malignancy during the first 6 months after diagnosis. Malignancies were found using simple clinical and diagnostic methods; additional screening was not cost-efficient. Other signs associated with deep venous thrombosis that increased the probability of an occult cancer were age older than 50 years, multiple sites of venous thrombosis, associated venous and arterial thromboembolism, thromboembolism resistant to warfarin therapy, and paraneoplastic syndrome. Among vascular syndromes, only cutaneous leukocytoclastic vasculitis presenting after the age of 50 years was consistently associated with cancer. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role as a tumor marker. The sensitivity for all samples analyzed from cancer patients was 80% and the specificity was 83%. CONCLUSIONS Data from the literature enabled us to outline clinical clues that might distinguish patients with cancer-associated vasculopathies from those unaffected by malignancies. Preliminary data with an antigen specific to tumor tissue, the cancer procoagulant, suggested its possible role in detecting early stage cancer. However, large-scale prospective studies are not currently available to evaluate the role of these clues and laboratory assays in the diagnosis of early stage cancer.
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Affiliation(s)
- J E Naschitz
- Department of Internal Medicine A, the Bnai Zion Medical Center, Haifa, Israel
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44
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Sato Y, Marutsuka K, Asada Y, Yamada M, Setoguchi T, Sumiyoshi A. Pulmonary tumor thrombotic microangiopathy. Pathol Int 1995; 45:436-40. [PMID: 7581935 DOI: 10.1111/j.1440-1827.1995.tb03481.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is characterized by widespread fibrocellular intimal proliferation of the small pulmonary arteries and arterioles in patients with metastatic carcinoma. Microscopic pulmonary tumor emboli have frequently occurred in patients with malignant tumors; however, few cases of PTTM have been reported. A rare case of a patient with gastric adenocarcinoma who presented with acute dyspnea and lethal respiratory failure is described. Histologically, diffuse fibromuscular intimal thickening causing luminal stenosis and obstruction but containing rather few cancer cells was observed in the small pulmonary arteries and arterioles. These findings were consistent with PTTM. Although PTTM is a rare phenomenon, PTTM should be considered in the differential diagnosis of acute dyspnea or pulmonary hypertension in patients with carcinoma.
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Affiliation(s)
- Y Sato
- First Department of Pathology, Miyazaki Medical College, Japan
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45
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46
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Yutani C, Imakita M, Ishibashi-Ueda H, Katsuragi M, Yoshioka T, Kunieda T. Pulmonary hypertension due to tumor emboli: a report of three autopsy cases with morphological correlations to radiological findings. ACTA PATHOLOGICA JAPONICA 1993; 43:135-41. [PMID: 8484335 DOI: 10.1111/j.1440-1827.1993.tb01122.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Three cases of pulmonary hypertension caused by tumor emboli to the lungs are described. Two of the three cases had a clinical diagnosis of pulmonary thromboembolism until surgical embolectomy, and the other had a diagnosis of primary pulmonary hypertension. Autopsy disclosed chondrosarcoma, choriocarcinoma and gastric cancer as the primary tumors, respectively. Pulmonary vascular obstruction due to tumor embolism leading to pulmonary hypertension is a previously rare clinical entity, and obstructed pulmonary vessels are believed to tend to be small vessels. We compared the autopsy and radiological findings and concluded that pulmonary tumor embolism involved not only the small peripheral arteries but also the segmental and/or lobar arteries.
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Affiliation(s)
- C Yutani
- Department of Pathology, National Cardiovascular Center, Osaka, Japan
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Abstract
The multitude of classic manifestations of paraneoplastic thromboembolism (TE), including new aspects, are reviewed. This emphasizes the complexity of the situation that the physician faces in dealing with paraneoplastic TE. Unexplained TE may serve as a hint for the presence of a hidden tumor. However, efforts to uncover such an underlying malignancy often are unrewarding. The view has been expressed that it is inappropriate to conduct an extensive search for an occult neoplasm unless there are more specific indications. A recent study defined clues that might separate patients with TE and occult cancer from those unaffected by a malignant neoplasm. The study of the hemostatic alterations in patients with cancer underscores the triple role of cancer cells in the pathogenesis of TE: injury to the endothelial lining of blood vessels, activation of platelets, and activation of blood coagulation and depression of anticoagulant functions. The failure of standard anticoagulant treatment in many instances is better understood. Novel approaches to treatment include low-molecular-weight heparin(s) for long-term administration or, alternatively, the initial placement of a Greenfield filter in the vena cava instead of anticoagulant therapy. Either of these may provide superior results in comparison to standard heparin treatment.
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Affiliation(s)
- J E Naschitz
- Department of Internal Medicine A, Bnai Zion Medical Center, Haifa, Israel
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48
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Pulmonary hypertension attributable to neoplastic emboli: An autopsy study of 20 cases and a review of literature. Cardiovasc Pathol 1992; 1:279-87. [DOI: 10.1016/1054-8807(92)90038-p] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/1992] [Accepted: 08/11/1992] [Indexed: 01/04/2023] Open
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Soares FA, Landell GA, de Oliveira JA. A prospective study of the morphological aspects of tumor involvement of the pulmonary vessels. Pathology 1992; 24:150-4. [PMID: 1437286 DOI: 10.3109/00313029209063163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A prospective morphological study of tumor involvement of the pulmonary vessels (TIPV) was undertaken on 203 consecutive autopsy cases of malignancies. The lungs were removed as a block and 15 sections (3 from each lobe) were analyzed. Site of origin, histological type and staging of the tumor, topographic distribution of the tumor emboli in the lungs, right ventricular hypertrophy and dilatation, pulmonary infarct, pulmonary vascular sclerosis and lung metastases were recorded in each case. TIPV was detected in 84 (41.4%) cases, the highest frequency reported until now. In 28 cases, TIPV was considered to be the main cause of death. The breast, liver, and pancreas were primary sites in more than 50% of the cases in which TIPV was observed. TIPV was more prevalent in epithelial neoplasms and showed a strong correlation with advanced disease. There was no significant difference among topographic regions of the lungs. The cases with TIPV were correlated with a high frequency of right ventricular hypertrophy and dilatation, vascular sclerosis and pulmonary metastases but not with pulmonary infarcts.
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Affiliation(s)
- F A Soares
- Department of Pathology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
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Soares FA, Landell GA, de Oliveira JA. Clinical aspects of tumour involvement of the pulmonary vessels. Acta Oncol 1992; 31:519-23. [PMID: 1419097 DOI: 10.3109/02841869209088300] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The involvement of the pulmonary vessels by tumour emboli may lead to a clinical picture defined as 'subacute cor pulmonale'. Information about this syndrome has been limited to case reports and a few series. A study of 214 autopsied cancer patients was undertaken to investigate the clinical signs and symptoms of tumour involvement of the pulmonary vessels (TIPV). The lungs were removed as a block and 15 sections (3 from each lobe) were analyzed. Clinical data about right ventricular failure, dyspnoea, cough, pleuritic chest pain, cyanosis, engorgement of jugular veins, peripheral oedema, haemoptysis and haemoptoic sputum were obtained from the medical records of each patient. Tumour emboli were detected in 89 cases, and no respiratory symptoms were recorded in 39. The presence of dyspnoea and cyanosis were highly significant in the group with TIVP, and right ventricular failure and peripheral oedema showed slight significant differences between the patients with and without TIPV. The classical picture of subacute cor pulmonale was observed in 13 patients and TIPV was considered to be the main cause of death in 29 cases. Our results indicate that although the development of subacute cor pulmonale was rare in patients with cancer, TIPV may be suspected when the patient presents respiratory distress and should be included in the differential diagnosis of dyspnoea in cancer patients.
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Affiliation(s)
- F A Soares
- Department of Pathology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil
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