Spontaneous Systemic Tumor Embolism Caused by Tumor Invasion of Pulmonary Vein in a Patient with Advanced Lung Cancer

Abstract

We describe a 72-year-old man who presented with left hemiparesis due to acute cerebral infarction in the right fronto-temporal lobe. Three months prior to admission, he was hospitalized for right hemiparesis due to the acute cerebral infarction in the left anterior cerebral artery territory. To investigate the cause of his recurrent embolic event, a chest computed tomography scan and echocardiography were performed, which revealed advanced lung cancer invading contiguously through the pulmonary veins to the right main pulmonary artery and left atrium. Tumor embolism is a rare cause of stroke, occurring with primary or metastatic neoplasms of the lung. Echocardiography is a useful tool in patients with cerebral embolic episodes.

Spindle Cell Component in Pleomorphic Carcinoma Showing Polypoid Growth in the Pulmonary Vein

“…10) Preoperative computed tomography or ultrasonography are useful for precise evaluation of tumor growth and potential risks of tumor embolism. 8,9) The best way to prevent tumor embolism is surgical resection with early clamping or ligation of the invaded vessels with minimal dissection as we performed in the present case. 11) Cardiopulmonary bypass may be required to avoid incomplete resection when the tumor extends into the atrium.…”

“…Several cases have been reported on spontaneous systemic tumor embolization caused by tumor invasion to the pulmonary veins. 8,9) Tumor emboli are very fragile and an even gentle manipulation can lead to emboli release or infarction. 10) Preoperative computed tomography or ultrasonography are useful for precise evaluation of tumor growth and potential risks of tumor embolism.…”

Lung Cancer With Tumor Emboli

“…Many primary tumor emboli described in the literature have been adenocarcinoma, and the majority of emboli from metastatic lung tumors are sarcomas [1][2][3]. Tumor embolus most commonly occurs at the aortic bifurcation or the femoral vessels (50%) and in the cerebral circulation (30%) [4].…”

“…Reasons for not operating included distant metastases of the primary tumor [2], poor surgical candidate after sequelae of the embolism [6], or death after the embolism or its sequelae. There are, however, techniques to reduce the risk of intraoperative or postoperative embolism when tumors invading the pulmonary veins are resected.…”

“…The proximity of the thoracic duct and collateral channels to the esophagus and a highly variable course contribute to an incidence of ductal injury during esophageal mobilization ranging from 1% to 9 % [1,2]. Because chylothorax leads to malnutrition, immunosuppression, and respiratory compromise through the loss of large amounts of fluid, electrolytes, protein, fat, fat-soluble vitamins, and lymphocytes, it has a significant impact on postoperative morbidity and mortality [3].…”