Pulmonary tumor embolism: a review of the literature

Roberts, Kari E.; Hamele‐Bena, Diane; Saqi, Anjali; Stein, C. A.; Cole, Randolph P.

doi:10.1016/s0002-9343(03)00305-x

Cited by 239 publications

(255 citation statements)

References 25 publications

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“…Pulmonary tumour embolism is a related condition in which coagulated tumour cells obstruct the pulmonary microcirculation without changes in pulmonary vessel architecture [7]. By definition, pulmonary metastases and larger pulmonary emboli are excluded.…”

Section: Mcp 220514mentioning

confidence: 99%

Pulmonary tumour thrombotic microangiopathy

Price

Wells

Wort

2016

Current Opinion in Pulmonary Medicine

120

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Purpose of review Pulmonary tumour thrombotic microangiopathy (PTTM) describes tumour cell microemboli with occlusive fibrointimal remodelling in small pulmonary arteries, veins and lymphatics. Progressive vessel occlusion ultimately results in pulmonary hypertension, which is often severe and rapid in onset. PTTM is associated with carcinomas, notably gastric carcinoma, with vascular endothelial growth factor and platelet-derived growth factor signalling implicated in driving the intimal remodelling. PTTM is a rare cause of pulmonary hypertension, but given that up to a quarter of autopsy specimens from patients dying of carcinoma show evidence for PTTM, it is probably underdiagnosed AQ5 . Recent findingsUntil recently, prognosis in PTTM was universally abysmal from weeks to a few months. Diagnostic utilities include aspiration of tumour cells at wedged right heart catheterization, HRCT AQ6 findings and computed tomography-positron emission tomography (CT-PET), although definitive diagnosis requires histological analysis. Reports of PTTM treated with a combination of targeted pulmonary vasodilator therapies, anticoagulation, specific chemotherapy and platelet-derived growth factor inhibition, for example using imatinib, suggest that these approaches can prolong survival.Summary PTTM is increasingly recognized as an important cause of pulmonary hypertension, often in patients presenting with new-onset pulmonary hypertension and as yet undiagnosed malignancy. Prospects of survival are improving with targeted combination therapy, and early recognition and diagnosis are likely to be the key factors to improve outcome.

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Section: Mcp 220514mentioning

confidence: 99%

Pulmonary tumour thrombotic microangiopathy

Price

Wells

Wort

2016

Current Opinion in Pulmonary Medicine

120

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“…Pulmonary thrombotic microangiopathy is uncommon, reported in only 3% to 26% of autopsied patients with solid tumors (19)(20)(21)(22), and is usually only diagnosed postmortem (23). In this condition, embolic tumor cells obstruct pulmonary vessels, activate the coagulation cascade (24), and produce infl ammatory mediators promoting thrombosis and intimal proliferation (23).…”

Section: Baylor University Medical Center Proceedingsmentioning

confidence: 99%

Malignant Rhabdoid Tumor of the Kidney Arising in an Adult Patient

Podduturi¹,

Campa-Thompson²,

Zhou³

et al. 2014

Baylor University Medical Center Proceedings

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Malignant rhabdoid tumors (MRT) of the kidney are rare in children and even less common in adults, with only six previously reported adult cases. We present the case of a 60-year-old man with an MRT arising in the left kidney with extensive pulmonary micrometastases and thromboembolism resulting in thrombotic pulmonary microangiopathy (pulmonary tumor embolism syndrome). MRT is an extremely aggressive neoplasm with a short survival time.M alignant rhabdoid tumor (MRT) of the kidney is a highly aggressive, extremely rare neoplasm that is usually seen in children. Th e term rhabdoid is used because the tumor cells resemble rhabdomyoblasts but lack myogenic markers, and pathologic diagnosis requires familiarity with these microscopic features plus awareness that adult onset is possible. We describe clinical and necropsy fi ndings in an adult with primary renal MRT. CLINICAL HISTORYA 60-year-old white man with known hypothyroidism, hypertension, and chronic obstructive pulmonary disease had progressive fatigue and abdominal distension for 6 months and worsening dyspnea for 2 weeks. Imaging showed bilateral pulmonary infi ltrates consistent with pneumonia, and he was treated at home with antibiotics and prednisone. Th ree days later, he presented to an outside emergency department with gross hematuria, left calf pain, hemoptysis, painful testicular swelling, and nontraumatic ecchymoses. He was then transferred to Baylor University Medical Center at Dallas and admitted to the intensive care unit. Examination disclosed bilateral lower-extremity edema and ecchymosis over the left calf and ankle. His body mass index was 30.4 kg/m 2 , blood pressure, 170/90 mm Hg; heart rate, 96 beats/minute; respiratory rate, 18 breaths/minute; white blood cell count, 31.9 k/μL; hemoglobin, 9.3 g/dL; hematocrit, 25.9%; platelets, 81 k/μL; prothrombin time, 18.0 seconds (reference range 9.0-12.0 seconds); blood urea nitrogen, 46.0 mg/dL; creatinine, 1.6 mg/dL; and arterial blood gas pH, 7.38. He was given heparin and multiple units of red blood cells and cryoprecipitate. Chest radiograph showed bilateral basilar and right upper lobe infi ltrates. Computed tomography showed a thrombus within the left renal vein that extended into the inferior vena cava and a mass in the mid to lower pole of the left kidney (Figure 1).Over the next few days, the patient's oxygen requirements increased, his abdomen became more distended, and his urine output decreased. A left radical nephrectomy and retroperitoneal lymph node dissection was performed. At surgery, there was no residual thrombus in the left main renal vein. Postoperatively,

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“…종양색전증은 전이병변을 가진 암환자에서 혈관계의 종양 세포들로 정의할 수 있는데 1) , 그 발생률은 여러 연구들에서 차이가 나지만, 대략 3-26% 정도로 알려져 있다 2) . Sorensen Fig.…”

Section: 서 론unclassified

A Case of Thyroid Papillary Carcinoma With Pulmonary Tumor Embolism

Lee

Kwak

Kim

et al. 2013

J Korean Geriatr Soc

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The tumor embolism is defined as tumor cells within the vascular system such as pulmonary artery that is not contiguous with the other metastatic foci. The incidence of tumor embolism varies widely ranging from 3% to 26% among seve ral studies; whereas lung cancer, prostate cancer, colorectal cancer, breast cancer, pancreas cancer are associated with high risks for tumor embolism. However thyroid cancer is rarely associated with tumor embolism. Among the rare cases, tumor embolism was reported as being mostly of follicular carcinoma or undifferentiated carcinoma, but few of papillary carcinoma. We report an unusual presentation that pulmonary tumor embolism from thyroid papillary carcinoma was diagnosed with positron emission tomography/computed tomography (CT) and chest CT.

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Pulmonary tumor embolism: a review of the literature

Cited by 239 publications

References 25 publications

Pulmonary tumour thrombotic microangiopathy

Pulmonary tumour thrombotic microangiopathy

Malignant Rhabdoid Tumor of the Kidney Arising in an Adult Patient

A Case of Thyroid Papillary Carcinoma With Pulmonary Tumor Embolism

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