Pulmonary wedge aspiration cytology in the diagnosis of recurrent tumour embolism causing pulmonary arterial hypertension

Bhuvaneswaran, J.S.; Venkitachalam, C.G.; Sandhyamani, S

doi:10.1016/0167-5273(93)90040-n

Cited by 31 publications

(16 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This technique has a reported sensitivity of 80-88% and a specificity of 82-94% [5,6]. It is reported in both PTTM and pulmonary tumour embolism [37], but would not be able to distinguish between these. Of note, if the sample is not wedged, malignant cells from 'upstream' (i.e.…”

Section: Pulmonary Wedge Aspiration Cytology and Lung Biopsymentioning

confidence: 99%

Pulmonary tumour thrombotic microangiopathy

Price

Wells

Wort

2016

Current Opinion in Pulmonary Medicine

120

View full text Add to dashboard Cite

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.

show abstract

Section: Pulmonary Wedge Aspiration Cytology and Lung Biopsymentioning

confidence: 99%

Pulmonary tumour thrombotic microangiopathy

Price

Wells

Wort

2016

Current Opinion in Pulmonary Medicine

120

View full text Add to dashboard Cite

show abstract

“…The median survival time following the initiation of oxygen supplementation was nine days. There are some reports of the antemortem diagnosis of PTTM using pulmonary wedge aspiration cytology, lung biopsies, positron emission tomography or lung perfusion scans (12,(15)(16)(17)(18). However, PTTM is generally difficult to diagnose prior to death and is primarily detected based on pathologic findings, as observed in the present case.…”

Section: Discussionmentioning

confidence: 63%

Signet-ring Cell Carcinoma of the Gallbladder Complicated by Pulmonary Tumor Thrombotic Microangiopathy

et al. 2014

View full text Add to dashboard Cite

Biliary drainage was performed in a 71-year-old man with obstructive jaundice of unknown origin; however, he died due to acute pulmonary failure. At autopsy, proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC) to the subserosa and bile ducts without growth toward the gallbladder lumen. Furthermore, fibrocellular intimal proliferation, tumor emboli and organized thrombi were observed in the small pulmonary arteries. The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM). PTTM may present as rapidly progressive dyspnea, and a high level of clinical suspicion is required to make the differential diagnosis.

show abstract

“…In this setting, a case of IVL was diagnosed early by thoracoscopic lung biopsy, allowing effective treatment by chemotherapy [15]. It was recently proposed that cytologic examination of pulmonary capillary blood aspiration by right-sided heart catheterization could demonstrate the presence of malignant cells in cases presenting as pulmonary embolism and/or primitive pulmonary arterial hypertension [16,17]. In the case of IVL mimicking pulmonary embolism, reported by Demirer et al, the initial diagnosis was obtained with transbronchial biopsy whereas the diagnosis of relapse was obtained on staining of mononuclear blood cells collected via pulmonary capillary-wedge aspiration [4].…”

Section: Discussionmentioning

confidence: 99%

Severe pulmonary arterial hypertension as initial manifestation of intravascular lymphoma: Case report

et al. 2005

View full text Add to dashboard Cite

Intravascular lymphoma (IVL) is a rare and usually fatal disease that belongs to the class of high-grade malignant lymphomas and which is characterized by proliferation of neoplastic lymphoid cells exclusively within the lumina of small blood vessels. Its polymorphic and nonspecific clinical manifestations make antemortem diagnosis very difficult. We report herein a case of IVL revealed by fatal, precapillary, pulmonary arterial hypertension and associated with long-lasting fever. Extensive investigation of the usual causes of pulmonary arterial hypertension was negative. The diagnosis of intravascular lymphoma was made on postmortem analysis, revealing diffuse and sometimes complete obliterations of the lumina of small blood vessels by large B-cell lymphoma, including pulmonary capillaries. Thus, we propose that IVL must be added to the spectrum of etiologies of subacute pulmonary arterial hypertension, notably in the context of associated fever, both entities requiring emergency diagnosis. For this purpose, blood collected via pulmonary capillary-wedge aspiration for cytologic examination may be associated with right-sided heart catheterization when this latter procedure is suitable. Am.

show abstract

Pulmonary wedge aspiration cytology in the diagnosis of recurrent tumour embolism causing pulmonary arterial hypertension

Cited by 31 publications

References 4 publications

Pulmonary tumour thrombotic microangiopathy

Pulmonary tumour thrombotic microangiopathy

Signet-ring Cell Carcinoma of the Gallbladder Complicated by Pulmonary Tumor Thrombotic Microangiopathy

Severe pulmonary arterial hypertension as initial manifestation of intravascular lymphoma: Case report

Contact Info

Product

Resources

About