Rapid Fatal Outcome from Pulmonary Arteries Compression in Transitional Cell Carcinoma

Voutsadakis, Ioannis A.; Masouris, George; Tsapakidis, Konstantinos; Papandreou, Christos N.

doi:10.1155/2009/579407

Cited by 4 publications

(5 citation statements)

References 19 publications

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“…Finally, mechanical compression of pulmonary vessels by metastatic hilar lymph node, which may increase pulmonary arterial pressure, has also been reported. 8 Disseminated pulmonary tumor embolism is a common autopsy finding in patients with cancer, but it is rarely diagnosed premortem. 2 It should be suspected in a patient with cancer who has dyspnea, hypoxemia, and unexplained PH.…”

Section: Discussionmentioning

confidence: 99%

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Acute Pulmonary Hypertension Caused by Tumor Embolism: A Report of Two Cases

Mury

Schneider

Nobile³

et al. 2015

Pulm. circ.

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a These authors contributed equally to this work.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.Keywords: acute pulmonary hypertension, acute right ventricular failure, neoplastic pulmonary hypertension. The acute onset of pulmonary hypertension (PH) associated with right ventricular (RV) failure is generally caused by deep venous thrombosis followed by proximal embolization of the pulmonary circulation. Much less commonly, other pathological processes can result in pulmonary vascular occlusion and acute PH, as illustrated by the report of two patients with massive obstruction of the distal pulmonary vasculature by circulating tumor cells followed by acute RV failure and death. CASE REPORTSPatient 1 was a 67-year-old man with a history of nonmetastatic bladder cancer treated by cystectomy 9 months before presentation and a recent uncomplicated incisional hernia repair. He presented to a community hospital with dyspnea and general weakness. Physical examination, chest radiograph, and electrocardiogram findings and laboratory test results were unremarkable except for a urine culture positive for Escherichia coli. Treatment with oral ciprofloxacin was started. After 3 days, the patient's condition deteriorated, with worsening dyspnea and hypotension. Computed tomography (CT) of the chest was described as unremarkable and, in particular, ruled out pulmonary embolism or pneumonia. The patient was admitted to the intensive care unit (ICU) for possible urosepsis and was treated with piperacillin-tazobactam and norepinephrine. Because of further deterioration of his condition, he was transferred to our institution. On arrival, severe hypoxemia, lactic acidosis (lactate level, 15 mmol/L), and muscular exhaustion were noted, and urgent endotracheal intubation was required. The procedure was complicated by severe hypotension and pulseless electrical activity cardiac arrest. A transesophageal electrocardiogram (ECG) obtained during cardiopulmonary resuscitation (CPR) revealed massive RV dilatation. CPR was stopped after 45 minutes due to refractory cardiac arrest. Clinical diagnosis was cardiogenic shock due to acute RV failure of unknown etiology. Postmortem examination revealed innumerable carcinomatous microemboli massively showering pulmonary capillaries, which explained the resulting PH. As a consequence, myointimal hyperplasia and thrombosis of medium-sized arteries were observed, as was capillary congestion (Fig. 1A-1D). Tumor microemboli were also found in massively dilated hepatic sinusoids, the heart, the spleen, and the pancreas. Despite extensive sampling, tumor cells were found only within vessels, wi...

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Section: Discussionmentioning

confidence: 99%

“…Finally, mechanical compression of pulmonary vessels by metastatic hilar lymph node, which may increase pulmonary arterial pressure, has also been reported. 8…”

Section: Discussionmentioning

confidence: 99%

Acute Pulmonary Hypertension Caused by Tumor Embolism: A Report of Two Cases

Mury

Schneider

Nobile³

et al. 2015

Pulm. circ.

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“…The patient died 10 months later due to bleeding from a brain metastasis [ 8 ]. None of the other cases survived more than one month, although one had initial improvement with chemoradiation [ 9 – 11 ].…”

Section: Discussionmentioning

confidence: 99%

Urothelial Superior Vena Cava Syndrome with Limited Response to Radiation Therapy

Bingham

Wallace

Monterroso

et al. 2015

Case Reports in Oncological Medicine

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Radiation therapy (RT) is the standard of care for cases of superior vena cava (SVC) syndrome secondary to metastatic adenopathy. Histologies vary in radiosensitivity and response time, making alternative therapies such as chemotherapy and/or intravenous stenting preferable alternative options for certain diagnoses. Metastatic urothelial carcinoma is a particularly rare cause of SVC syndrome with only 3 cases reported in the literature. Consequently, optimal management remains challenging, particularly in cases of high tumor burden. Here we present a case of highly advanced metastatic urothelial cancer with SVC syndrome and tracheal compression. The patient started urgent RT but expired midway through her treatment course due to systemic progression of disease, requiring SVC and tracheal stenting. The authors review the literature including discussion of the few other known cases of SVC syndrome due to urothelial carcinoma and a review of this histology's response to RT. This experience suggests, that in cases of SVC syndrome with widespread advanced disease, stenting and chemotherapy with or without RT may be the most important initial treatment plan, depending on goals of care.

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“…-Methotrexate: Hypersensitivity pneumonitis, opportunistic lung infections, lymphoproliferative disease of lung [43] Sarcoid like Reaction [49] mediastinal lymphadenopathy due to metastatic disease was noted to cause pulmonary artery compression [14]. Such involvement may be associated with features of lymphangitic carcinomatosis.…”

Section: Pulmonary and Mediastinal Metastatic Diseasementioning

confidence: 99%

Pulmonary manifestations of urothelial carcinoma of the bladder

Sahni

Vulisha

Gumpeni

et al. 2017

Respiratory Medicine

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Urothelial carcinoma (Transitional cell carcinoma) of the bladder is the pre-dominant histological type of bladder cancer in the United States and Europe. Patients with bladder cancer usually present with painless hematuria. The diagnosis is often delayed, as the symptoms are similar to various other benign conditions such as urinary tract infection, prostatitis or renal calculi. In some patients, the metastatic lesions will cause the initial presenting symptoms. We conducted a MedLine/PubMED search identifying all relevant articles with "pulmonary manifestations", "urothelial bladder cancer", "manifestations of bladder cancer" or a combination of these terms in the title. The pulmonary manifestations of urothelial carcinoma of the bladder include metastatic disease including cavitary lesions, endobronchial, pleural, or lymph node metastasis pleural effusion and chylothorax. Pulmonary embolism and tumor embolism is another manifestation of this cancer. Intravesical Bacillus Calmette-Gurin therapy for bladder cancer has been associated with a range of adverse effects including the systemic spread of Bacilli Calmette-Guérin immunotherapy affecting the lungs. Other drugs used to treat bladder cancer can be associated with drug-related pneumonitis. Other rare manifestations include a sarcoid like reaction and systemic granulomatous disease to Bacilli Calmette-Guérin therapy. In this review we discuss the various pulmonary manifestations of urothelial carcinoma of the bladder. A high index of suspicion with these presentations can lead to an early diagnosis and assist in instituting an appropriate intervention.

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Rapid Fatal Outcome from Pulmonary Arteries Compression in Transitional Cell Carcinoma

Cited by 4 publications

References 19 publications

Acute Pulmonary Hypertension Caused by Tumor Embolism: A Report of Two Cases

Acute Pulmonary Hypertension Caused by Tumor Embolism: A Report of Two Cases

Urothelial Superior Vena Cava Syndrome with Limited Response to Radiation Therapy

Pulmonary manifestations of urothelial carcinoma of the bladder

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