Vascular Invasion by Chondrosarcoma Simulating Pulmonary Emboli<sup>1,</sup><sup>2</sup>

Schwarz, Marvin I.; Goldman, Allan L.; Roycroft, David; Hunt, Keith K.

doi:10.1164/arrd.1972.106.1.109

Cited by 12 publications

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“…2,[4][5][6][7][8] In patients with chondrosarcoma presenting symptoms such as shortness of breath, primary pulmonary tumour embolism has often been detected first on postmortem examination. 4,9,10 A series of autopsies discovered pulmonary tumour emboli in 8.3% of cases and considered they had contributed to the death of the patient.…”

Section: -3mentioning

confidence: 99%

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Newkirk

Vater

Oxorn

et al. 2003

Can J Anesth/J Can Anesth

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Section: -3mentioning

confidence: 99%

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Newkirk

Vater

Oxorn

et al. 2003

Can J Anesth/J Can Anesth

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“…Diffuse tumor within the pulmonary perivascular lymphatics is termed carcinomatosis lymphangitis and may lead to compression of alveoli and capillaries (with or without arterial invasion) [ 21 ]. These mechanisms are not mutually exclusive, as TE can occur from several mechanisms concurrently [ 22 ]. However, pulmonary endarteritis is the common end result [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…These mechanisms are not mutually exclusive, as TE can occur from several mechanisms concurrently [ 22 ]. However, pulmonary endarteritis is the common end result [ 22 ]. Similar mechanisms are responsible for TE in sarcoma [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary tumor embolism secondary to soft tissue and bone sarcomas: a case report and literature review

et al. 2017

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BackgroundTumor embolisms (TE) are an underappreciated source of pulmonary embolisms in sarcoma. Most evidence in the literature is limited to case reports and none have described the presence of TE secondary to myxofibrosarcoma. We report the first case of myxofibrosarcoma TE and perform a review of the literature for TE secondary to bone and soft tissue sarcomas (STS).Case presentationA 36-year-old female presented with debilitating pain of the right upper extremity secondary to a recurrent soft tissue sarcoma. She had distant metastasis to the lung. An MRI revealed a 25-cm shoulder mass involving the proximal arm muscles with encasement of the axillary artery, vein, and brachial plexus. A palliative forequarter amputation was performed and tumor thrombus was evident within the axillary artery and vein. Postoperatively, she developed an acute onset of dyspnea and hypoxia. A computed tomography scan revealed a pulmonary saddle embolism. A bilateral lower extremity venous duplex was negative. She became hemodynamically unstable despite resuscitation and was placed on vasopressor support. A transthoracic echocardiogram revealed elevated pulmonary artery pressure, tricuspid regurgitation, right heart dilation, and reduced right heart systolic function consistent with acute cor pulmonale. The patient did not want to pursue a median sternotomy with pulmonary artery embolectomy and expired from cardiopulmonary arrest within 24 h of the operation. The final pathology revealed a 25 × 16 × 13 cm high-grade myxofibrosarcoma with invasion into the bone, skin, and neurovascular bundle as well as evidence of tumor thrombus.ConclusionTE is a rare but deadly cause of pulmonary embolism in sarcoma. A high index of suspicion is necessary in individuals who present with respiratory-related symptoms, especially dyspnea. Diagnostic confirmation with a computed tomography scan of the chest and echocardiogram should be rapid. Unlike venous thromboembolism, pulmonary embolectomy remains the preferred therapeutic approach.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-017-1223-3) contains supplementary material, which is available to authorized users.

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“…Vol. 32 T h e pathogenesis of the leukemic thrombi in the pulmonary blood vessels invites speculation. We d o not believe that they formed by trapping of leukemic cells i n ordinary thrombi or emboli, because the leukemic thrombi consisted almost entirely of immature, nucleated cells with only small amounts of fibrin and few red blood cells, and the white blood cell count was never high.…”

Section: Cancer September 1973mentioning

confidence: 99%

Leukemic cellular thrombi in pulmonary blood vessels.Subleukemic myelogenous leukemia following chloramphenicol-induced aplastic anemia

Meyer

Boxer

1973

Cancer

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After an 8‐year period of aplastic anemia following chloramphenicol therapy, a 39‐year‐old woman developed subleukemic acute myelogenous leukemia, and she died with Pseudomonas sepsis 18 months later. Autopsy demonstrated leukemic cellular thrombi that partially or completely occluded many small pulmonary arteries, arterioles, and small veins. Scattered among the leukemic cells in the thrombi were hemosiderotic histiocytes reflecting transfusional hemosiderosis. The staining characteristics, esterase activity, and electron microscopic appearances of the cellular thrombi confirmed their myeloid leukemic nature. The leukemic cells were cemented together by fibrin. We propose that the leukemic cells produced procoagulants that initiated coagulation on their surfaces, and that the leukemic thrombi are the morphological counterpart of a local accelerated intravascular coagulopathy. The possible clinical significance of pulmonary leukemic thrombi is discussed.

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Vascular Invasion by Chondrosarcoma Simulating Pulmonary Emboli^1,²

Cited by 12 publications

References 0 publications

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Pulmonary tumor embolism secondary to soft tissue and bone sarcomas: a case report and literature review

Leukemic cellular thrombi in pulmonary blood vessels.Subleukemic myelogenous leukemia following chloramphenicol-induced aplastic anemia

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Vascular Invasion by Chondrosarcoma Simulating Pulmonary Emboli1,2

Cited by 12 publications

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Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Pulmonary tumor embolism secondary to soft tissue and bone sarcomas: a case report and literature review

Leukemic cellular thrombi in pulmonary blood vessels.Subleukemic myelogenous leukemia following chloramphenicol-induced aplastic anemia

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Vascular Invasion by Chondrosarcoma Simulating Pulmonary Emboli^1,²