Pulmonary Tumor Thrombotic Microangiopathy Caused by a Gastric Cancer

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Background. Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare complication of malignant tumors. Most cases are fatal because of respiratory failure associated with rapidly progressing pulmonary hypertension and right heart failure. The diagnosis is extremely difficult and is most often established at postmortem. Case. A 36-year-old man presented with shortness of breath. A computed tomography (CT) scan showed moderate abnormal shadows in lung fields and multiple lymphadenopathies. He underwent a transbronchial lung biopsy; however, no diagnosis was achieved. One month later, he died because of severe respiratory failure. An autopsy revealed gastric cancer with multiple lymph node metastases. Emboli and thrombus composed of tumor cells were observed in the pulmonary arteries and arterioles. Furthermore, intimal myofibroblasts were apparent. The gastric specimens were immunohistochemically positive for vascular endothelial growth factor (VEGF) and serum VEGF levels were high. From these findings, we diagnosed the patient with PTTM caused by gastric cancer. Conclusion. Patients with malignancy and rapidly progressing respiratory failure should be considered at risk of developing PTTM. It is useful to measure the level of serum VEGF, which might reflect the disease progression of PTTM.
2013-01-25