Systemic Tumor Embolism Mimicking Gefitinib ('IRESSA')-induced Interstitial Lung Disease in a Patient with Lung Cancer

Umemura, Shigeki; Kishino, Daizo; Tabata, Masahiro; Kiura, Katsuyuki; Hotta, Katsuyuki; Nishii, Kenji; Tanimoto, Yasushi; Kanehiro, Arihiko; Notohara, Kenji; Ueoka, Hiroshi; Tanimoto, Mitsune

doi:10.2169/internalmedicine.44.979

Cited by 5 publications

(1 citation statement)

References 19 publications

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“…Although these findings are not specific to PTE, the distribution of shadows and overall consideration of multiple findings may provide clues for the diagnosis of PTE. (11)(12)(13)(14)(15)(16)(17)(18). Of these, four cases had ground-glass opacities and consolidation, which suggested secondary changes caused by artery embolism, as well as no granular or nodular shadows, which directly indicated vascular occlusion.…”

Section: Discussionmentioning

confidence: 95%

Case of Pulmonary Tumor Embolism due to Oropharyngeal Carcinoma Diagnosed by a Transbronchial Lung Biopsy

Anai,

Hamada,

Jodai

et al. 2024

Intern. Med.

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Pulmonary tumor embolisms (PTEs) are primarily caused by adenocarcinoma. However, only a few cases of oropharyngeal carcinoma have been reported. We herein report a 47-year-old man who presented with a fever, cough, and dyspnea 6 months after treatment for stage II oropharyngeal carcinoma. Chest computed tomography revealed centrilobular granular and nodular shadows and subpleural consolidation. A transbronchial lung biopsy revealed a mass of squamous tumor cells forming emboli in the small vessels, resulting in the diagnosis of PTE due to oropharyngeal carcinoma. Therefore, PTE should be considered for patients with a history of hypoxia.

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Section: Discussionmentioning

confidence: 95%

Case of Pulmonary Tumor Embolism due to Oropharyngeal Carcinoma Diagnosed by a Transbronchial Lung Biopsy

Anai,

Hamada,

Jodai

et al. 2024

Intern. Med.

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Tyrosine Kinase Inhibitor-Induced Interstitial Lung Disease: Clinical Features, Diagnostic Challenges, and Therapeutic Dilemmas

Shah

2016

Drug Saf

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Since the approval of the first molecularly targeted tyrosine kinase inhibitor (TKI), imatinib, in 2001, TKIs have heralded a new era in the treatment of many cancers. Among their innumerable adverse effects, interstitial lung disease (ILD) is one of the most serious, presenting most frequently with dyspnea, cough, fever, and hypoxemia, and often treated with steroids. Of the 28 currently approved TKIs, 16 (57 %) are reported to induce ILD with varying frequency and/or severity. The interval from drug administration to onset of ILD varies between patients and between TKIs, with no predictable time course. Its incidence is variously reported to be approximately 1.6-4.3 % in Japanese populations and 0.3-1.0 % in non-Japanese populations. The mortality rate is in the range of 20-50 %. Available evidence (primarily following the use of erlotinib and gefitinib in Japan because of the unique susceptibility of that population) has identified a number of susceptibility and prognostic risk factors (male sex, a history of smoking, and pre-existing pulmonary fibrosis being the main ones). Although the precise mechanism is not understood, collective evidence suggests that immune factors may be involved. If TKI-induced ILD is confirmed by thorough evaluation of the patient and exclusion of other causes, management is supportive, and includes discontinuation of the culprit TKI and administration of steroids. Discontinuing the culprit TKI presents a clinical dilemma because the diagnosis of TKI-induced ILD in a patient with pre-existing pulmonary fibrosis can be challenging, the patient may have TKI-responsive cancer with no suitable alternative, and switching to an alternative agent, even if available, carries the risk of the patient experiencing other toxic effects. Preliminary evidence suggests that therapy with the culprit TKI may be continued under steroid cover and/or at a reduced dose. However, this approach requires careful individualized risk-benefit analysis and further clinical experience.

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Neoplastic embolization to systemic and pulmonary arteries

Bois

Eckhardt

Cracolici

et al. 2018

Journal of Vascular Surgery

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Systemic Tumor Embolism Mimicking Gefitinib ('IRESSA')-induced Interstitial Lung Disease in a Patient with Lung Cancer

Abstract: We describe a 55-year-old man with advanced adenocarcinoma of the lung who received gefitinib ('IRESSA').

Cited by 5 publications

References 19 publications

Case of Pulmonary Tumor Embolism due to Oropharyngeal Carcinoma Diagnosed by a Transbronchial Lung Biopsy

Case of Pulmonary Tumor Embolism due to Oropharyngeal Carcinoma Diagnosed by a Transbronchial Lung Biopsy

Tyrosine Kinase Inhibitor-Induced Interstitial Lung Disease: Clinical Features, Diagnostic Challenges, and Therapeutic Dilemmas

Neoplastic embolization to systemic and pulmonary arteries

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