Acute lower limb ischemia and intestinal necrosis due to arterial tumor embolism from advanced lung cancer: a case report and literature review

Abstract

BackgroundArterial tumor embolism (ATE) is a rare but life-threating complication.Presentation of caseA 55-year-old man with acute lower-limb ischemia was referred to our hospital after endovascular intervention failed and underwent above-the-knee amputation for severe limb necrosis. On postoperative day 8, he developed small bowel necrosis and underwent resection. Histopathological examination of the resected bowel revealed that the submucosal arterial emboli were positive for the markers of squamous cells. He had unresectable lung squamous cell carcinoma with left atrium invasion. The subsequent embolisms were thought to be caused by the advanced lung cancer.ConclusionATE is rare but should be considered as a differential diagnosis for unidentified arterial occlusion.

Acute mesenteric ischemia leading to diagnosis of advanced spindle cell carcinoma of the lung

“… 2 , 4 , 5 , 6 , 7 , 8 , 9 Our review identified only five other cases of primary lung cancer embolizing to the SMA. 11 , 12 , 13 , 14 , 15 However, of these cases, the present case was the only case in which the acute ischemic event had preceded the diagnosis of lung cancer. In each of the other five cases, the patients had either previously undergone treatment of unresectable lung cancer or had experienced embolic events perioperatively from the tumor or lung resection.…”

“…In each of the other five cases, the patients had either previously undergone treatment of unresectable lung cancer or had experienced embolic events perioperatively from the tumor or lung resection. 11 , 12 , 13 , 14 , 15 …”

Acute Limb Ischemia Caused by Embolus of Primary Lung Cancer Complicating Trousseau’s Syndrome

“…Some studies have reported that advanced lung cancer should be considered to be a differential diagnosis of arterial embolism. 3 , 5 – 7 ) The present case had a highly mobile mass in the LA, which was responsible for acute lower extremity ischemia. Since the mass could result in thrombus formation in the LA, we conducted echocardiography to confirm that it originated from the primary lung cancer with continuity.…”

“…Togo et al reported that the acute ischemic limb that develops because of primary lung cancer may require limb amputation. 5 ) Loscertales et al also reported surgical intervention to remove a tumor in the LA that was floating without atrial wall invasion in a patient with pulmonary adenocarcinoma; however, the patient died postoperatively. 10 ) The success of the surgical intervention might depend on the degree of adhesion with surrounding tissues, including the wall of the LA.…”

“…The prognosis was reported to be highly correlated with the TNM stage. 5 ) Nonetheless, even if a patient has an advanced stage of cancer, it is beneficial to excise the embolus to make a diagnosis and salvage the limb.…”