Imatinib Alleviated Pulmonary Hypertension Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient With Metastatic Breast Cancer

Fukada, Ippei; Araki, Kazuhiro; Minatsuki, Shun; Fujino, Takeo; Hatano, Masaru; Numakura, Satoe; Abé, Hiroyuki; Ushiku, Tetsuo; Iwase, Takuji; Ito, Yoshiaki

doi:10.1016/j.clbc.2014.10.008

Cited by 34 publications

(41 citation statements)

References 18 publications

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“…Detection of tumor cells by pulmonary microvascular cytology has been reported as an alternative method, 6,7) but it was not useful in our case. Considering the rapid progression of PTTM, it is pragmatic to initiate possible therapy if the disease is suspected and a comorbid adenocarcinoma is confirmed.…”

Section: Discussionmentioning

confidence: 63%

Pulmonary Tumor Thrombotic Microangiopathy due to Advanced Gastric Cancer with Virchow's Node Metastasis

et al. 2018

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SummaryPulmonary tumor thrombotic microangiopathy (PTTM) is a fatal cancer-related complication characterized by severe progressive pulmonary hypertension. Antemortem diagnosis is difficult owing to the rapid progression of the condition, especially when the patient has no known malignancies and initially presents with pulmonary hypertension. Here we report a case of PTTM due to occult gastric cancer with metastasis in the left supraclavicular lymph node, also known as Virchow's node. Enlarged Virchow's node is an important indicator of advanced gastric cancer. In patients with progressive pulmonary hypertension of unknown origin, enlarged Virchow's node can be an important indicator for the diagnosis of PTTM.(Int Heart J 2018; 59: 443-447) Key words: Pulmonary hypertension, Metastatic cancer P ulmonary tumor thrombotic microangiopathy (PTTM) is a fatal cancer-related complication characterized by severe progressive pulmonary hypertension.1) The majority of PTTM cases reported are associated with gastric cancer.2) Antemortem diagnosis is extremely difficult because of the rapid progression of PTTM, especially when the patient has no known malignancies and initially presents with pulmonary hypertension.3) As the enlargement of the left supraclavicular lymph node, also known as Virchow's node, is one of the important signs of advanced gastric cancer, 4) Virchow's node enlargement can suggest the diagnosis of PTTM. Here, we report a case of PTTM complicated by advanced gastric cancer with Virchow's node metastasis. Case ReportThe patient was a 65-year-old woman with a history of thyroid medullary carcinoma that was successfully resected two years ago; she had no history of smoking. She had been experiencing weight loss and dry cough for eight months. She had developed gradually worsening dyspnea on exertion, one month earlier. On examination at a nearby hospital, her oxygen saturation was 92%, with an increased level of fibrinogen degradation product (FDP; 75 μg/mL); echocardiography revealed a "D-shaped" left ventricle. The patient was suspected to be suffering from acute pulmonary embolism and was transferred to our hospital.At admission, her body temperature was 36.1°C, blood pressure was 180/80 mm Hg, heart rate was 83 bpm, respiratory rate was 16 breaths per minute, and oxygen saturation was 93% with oxygen supplementation at 3 L/minute. Physical examination revealed an increased intensity of second heart sound with no murmurs or rales. Only a rough palpation of systemic lymph nodes was performed, and enlargement of the left supraclavicular lymph node was not noticed. Laboratory examination showed mild thrombocytopenia (10.2 × 10 4 /μL) and increased biliary enzymes (gamma-glutamyl transpeptidase 103 IU/L; alkaline phosphatase 802 IU/L). Her hemoglobin concentration was within the normal range (12.6 g/dL). Coagulation test showed prolonged prothrombin time (15.3 seconds), with an increased level of FDP (32.0 μg/mL), Ddimer (24.1 μg/mL), thrombin-antithrombin complex (32.0 ng/mL), and plasmin-alfa-2 plasmin inh...

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Section: Discussionmentioning

confidence: 63%

Pulmonary Tumor Thrombotic Microangiopathy due to Advanced Gastric Cancer with Virchow's Node Metastasis

et al. 2018

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“…The primary site of tumor was upper gastrointestinal tract in 4 of them, breasts in 3 of them, unknown in two of them, and lungs in one of them. The diagnostic methods for PTTM were transbronchial lung biopsy in five patients [4,15,16,28,29], Video assisted thoracoscopic surgery in two of them [12,30], CT-guided biopsy [31] in one of them and rest two were presumptive ante mortem diagnoses based on the clinically proven pulmonary hypertension and presence of tumor cells obtained from wedged pulmonary artery catheter aspiration [32,33].…”

Section: Review Of Literature and Discussionmentioning

confidence: 99%

Fatal Pulmonary Tumour Thrombotic Microangiopathy (PTTM) Associated with Signet Ring Cell Carcinoma of Colon: An Autopsy Diagnosis

Subramanian¹

2017

Austin J Forensic Sci Criminol

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Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinicopathological entity in which the tumor cells embolize to the pulmonary vasculature leading to fibro cellular intimal thickening and arteriolar occlusion by cellular intimal proliferation. Sub-acute respiratory failure, pulmonary hypertension, right sided heart failure and sudden death may be seen due to consequences of stenosis of blood vessels.We describe a case of a 23 year old man who presented with alleged history of found unconscious and declared brought death. He was clinically diagnosed as refectory sepsis with ventilator associated pneumonia with acute kidney injury. Past history revealed Crohn's disease and treatment with Azathioprine and prednisolone. Mucicarmine was positive in colonic tumor as well as in pulmonary tumor cell emboli with recanalization and intimal fibro cellular proliferation of small arteries. A postmortem diagnosis of poorly differentiated signet ring cell carcinoma of colon with PTTM was made based on autopsy results.Unfortunately, PTTM is difficult to diagnose and is mostly a post mortem diagnosis with an extremely poor prognosis. Pulmonary hypertension due to metastatic tumor emboli should be included in the differential diagnosis of various causes of dyspnea in patients with cancer.

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“…High-resolution computed tomography findings are non-specific but may demonstrate ground glass opacification, mosaicism (reflecting small vessel occlusion) [5], small pulmonary nodules (due to fibrointimal thickening), diffuse shadows [6], consolidation, tree-in-bud [7] and interlobular septal thickening (when pulmonary vein or lymphatics are involved). Interestingly, the recent European Society of Cardiology/European Respiratory Society pulmonary hypertension guidelines suggest that computed tomography is useful in many respects, but does not emphasis the potential role for computed tomography (and/or ultrasound) of the abdomen and pelvis to assess for malignancy [8]. Indeed, as previously highlighted previously in this journal, computed tomography should pick up malignancy in rapidly progressive new cases of pulmonary hypertension [9].…”

Section: From the Authorsmentioning

confidence: 99%

“…After reviewing all cases published in PubMed-indexed journals, since the original description by VON HERBAY et al [3], we found six additional observations of such prolonged survival after a diagnosis of PTTM (table 1) [4][5][6][7][8][9]. These cases drew our attention because they could also be interesting to highlight the physiopathological mechanisms of PTTM and identify potential targeted therapies for this fatal condition.…”

mentioning

confidence: 89%

“…However, the effect of anti-VEGF antibody in this condition has to be evaluated in light of side-effects of this treatment, including thromboembolic events. In addition, four other patients were treated with imatinib, a tyrosine kinase inhibitor that inhibits platelet-derived growth factor (PDGF) receptors, at different dosages [2, [7][8][9]. Imatinib was associated in three cases with other chemotherapies acting on the VEGF pathway.…”

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confidence: 99%

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Is there hope of improving the prognosis of pulmonary tumour thrombotic microangiopathy?

et al. 2016

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Imatinib Alleviated Pulmonary Hypertension Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient With Metastatic Breast Cancer

Cited by 34 publications

References 18 publications

Pulmonary Tumor Thrombotic Microangiopathy due to Advanced Gastric Cancer with Virchow's Node Metastasis

Pulmonary Tumor Thrombotic Microangiopathy due to Advanced Gastric Cancer with Virchow's Node Metastasis

Fatal Pulmonary Tumour Thrombotic Microangiopathy (PTTM) Associated with Signet Ring Cell Carcinoma of Colon: An Autopsy Diagnosis

Is there hope of improving the prognosis of pulmonary tumour thrombotic microangiopathy?

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