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Attard TM, Omar U, Glynn EF, Stoecklein N, St Peter SD, Thomson MA. Gastric cancer in the pediatric population, a multicenter cross-sectional analysis of presentation and coexisting comorbidities. J Cancer Res Clin Oncol 2023; 149:1261-1272. [PMID: 35435488 DOI: 10.1007/s00432-022-03972-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Solid tumors of the stomach in children are rare, adenocarcinoma being most frequently reported. Risk factors and clinical presentation are poorly understood. We undertook a nationwide database analysis to evaluate pediatric CA stomach presentation, comorbidities, and metastatic pattern. METHODS The Cerner Health Facts Database® (CHFD) was queried for pediatric age range (1-21) patients, 2010-2017 inclusive. The pediatric gastric cancer cohort was defined by ICD9 and ICD 10 CM diagnoses attributable to primary (non-GIST, non-hematologic) solid tumors of the stomach limited to diagnosis priority < 5 and validated by filtering for supportive diagnoses. Demographic characteristics, comorbidities, before and throughout the medical record were analyzed and compared to the base population. RESULTS The cohort included 333 patients from a base population of 9.6 million children. The M:F ratio was 1.15:1, mean age at diagnosis was 11.8 years. Stomach cancer was most prevalent in non-Hispanic whites, less in Asians and African Americans. Symptoms included abdominal pain, vomiting, anemia, diarrhea and weight loss. Reflux symptoms, esophagitis, gastritis, including H. pylori and duodenitis were reported in 10.2%. Obesity, obesity-related comorbidities, tobacco exposure and family history of colonic polyps, gastrointestinal and breast cancer were all more prevalent (P < 0.0001) in the cohort. DISCUSSION We defined patient demographic characteristics, anatomic distribution in a large cohort of children with solid tumors of the stomach. Reported symptoms in our cohort are similar to those observed in adults. Associated comorbidities which may reflect risk factors include obesity, tobacco exposure and family history of intestinal polyps and malignancy.
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Affiliation(s)
- Thomas M Attard
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA. .,Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Uraizee Omar
- College of Osteopathic Medicine, Kansas City University, Kansas City, MO, USA
| | - Earl F Glynn
- Children's Mercy Research Institute, Kansas City, MO, USA
| | - Nicole Stoecklein
- Division of Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Shawn D St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield University, Sheffield, South Yorkshire, UK
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2
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Kawakami N, Moriya T, Kato R, Nakamura K, Saito H, Wakai Y, Saito K, Sakashita M. Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases. BMC Gastroenterol 2021; 21:423. [PMID: 34758740 PMCID: PMC8579618 DOI: 10.1186/s12876-021-02009-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/02/2021] [Indexed: 01/04/2023] Open
Abstract
Background Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported. Case presentation A previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer. Conclusions Despite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-02009-8.
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Affiliation(s)
- Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| | - Tomohiro Moriya
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Rina Kato
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kentaro Nakamura
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Hiroaki Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Yoko Wakai
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kazuhito Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Mai Sakashita
- Department of Pathology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
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Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease process in
which pulmonary hypertension (PH) develops in the setting of malignancy. The
purpose of this study is to present a detailed analysis of cases of PTTM
reported in literature in the hopes of achieving more ante-mortem diagnoses. We
conducted a systematic review of currently published and available cases of PTTM
by searching the term “pulmonary tumor thrombotic microangiopathy” on the
Pubmed.gov database. Seventy-nine publications were included consisting of 160
unique cases of PTTM. The most commonly reported malignancy was gastric
adenocarcinoma (94 cases, 59%). Cough and dyspnea were reported in 61 (85%) and
102 (94%) cases, respectively. Hypoxemia was reported in 96 cases (95%).
Elevation in D-dimer was noted in 36 cases (95%), presence of anemia in 32 cases
(84%), and thrombocytopenia in 30 cases (77%). Common findings on chest computed
tomography (CT) included ground-glass opacities (GGO) in 28 cases (82%) and
nodules in 24 cases (86%). PH on echocardiography was noted in 59 cases (89%)
with an average right ventricular systolic pressure of 71 mmHg. Common features
of PTTM that are reported across the published literature include presence of
dyspnea and cough, hypoxemia, with abnormal CT findings of GGO, nodules, and
mediastinal/hilar lymphadenopathy, and PH. PTTM is a universally fatal disease
process and this analysis provides a detailed examination of all the available
published data that may help clinicians establish an earlier diagnosis of
PTTM.
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Affiliation(s)
- Rohit H Godbole
- 1 Division of Pulmonary and Critical Care Medicine, University of California, Irvine, CA, USA
| | - Rajan Saggar
- 2 Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles David Geffen School of medicine, Los Angeles, CA, USA
| | - Nader Kamangar
- 3 Division of Pulmonary and Critical Care Medicine, Olive View - UCLA Medical Center, Los Angeles, CA, USA
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Merad M, Alibay A, Ammari S, Antoun S, Bouguerba A, Ayed S, Vincent F. [Pulmonary tumor thrombotic microangiopathy]. Rev Mal Respir 2017; 34:1045-1057. [PMID: 29153757 DOI: 10.1016/j.rmr.2017.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/08/2017] [Indexed: 12/25/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.
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Affiliation(s)
- M Merad
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - A Alibay
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - S Ammari
- Service de radiologie, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - S Antoun
- Service d'urgence en oncologie médicale, Gustave-Roussy Cancer Campus Grand Paris, Villejuif, 94805 Villejuif cedex, France
| | - A Bouguerba
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France
| | - S Ayed
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France
| | - F Vincent
- Réanimation polyvalente, GHIC Le-Raincy Montfermeil, 93370 Montfermeil, France.
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5
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Saliba J, Cherrick I, Wali P. An Adolescent With Cough and Dyspepsia. Clin Pediatr (Phila) 2016; 55:776-8. [PMID: 26354781 DOI: 10.1177/0009922815606418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joyce Saliba
- Golisano Children's Hospital, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Irene Cherrick
- Golisano Children's Hospital, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Prateek Wali
- Golisano Children's Hospital, SUNY Upstate Medical University, Syracuse, NY, USA
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6
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Patrignani A, Purcaro A, Calcagnoli F, Mandolesi A, Bearzi I, Ciampani N. Pulmonary tumor thrombotic microangiopathy: the challenge of the antemortem diagnosis. J Cardiovasc Med (Hagerstown) 2015; 15:828-33. [PMID: 22710763 DOI: 10.2459/jcm.0b013e328354e473] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is known as a rare and severe cancer-related pulmonary complication. Nowadays, fewer than 80 cases have been reported in the literature and very few cases have been diagnosed antemortem. We describe an autopsy case of PTTM associated with cancer of unknown origin. A 56-year-old male patient came to our attention due to a 2-day history of dyspnea. Analysis of the clinical context in combination with laboratory and imaging tests led us to suspect acute pulmonary thromboembolism. However, the computed tomography pulmonary angiogram was negative for thromboembolism; on the contrary it revealed multiple lymphadenopathy. Microscopic pulmonary tumor embolism was suspected and a lymph node biopsy was planned. However, the patient's condition progressively worsened; death occurred 3 days after admission. After autopsy, histologically extensive neoplastic emboli involved the small pulmonary arteries and arterioles, often admixed with fibrin thrombi. The involved and noninvolved arteries also demonstrated fibrocellular intimal proliferation causing marked luminal stenosis and occlusion. These pathological features were characteristic of PTTM, which should be distinguished from microscopic tumor embolism and should be considered in the differential diagnosis of acute/subacute cor pulmonale and pulmonary hypertension in cancer as well as in noncancer patients. We propose a review of the literature and an algorithm to improve PTTM antemortem diagnosis.
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Affiliation(s)
- Anna Patrignani
- aCardiology Department, Area Vasta n° 2, Senigallia bCardiology Department cPathology Department, Ospedali Riuniti, Ancona, Italy
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7
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Gainza E, Fernández S, Martínez D, Castro P, Bosch X, Ramírez J, Pereira A, Cibeira MT, Esteve J, Nicolás JM. Pulmonary tumor thrombotic microangiopathy: report of 3 cases and review of the literature. Medicine (Baltimore) 2014; 93:359-363. [PMID: 25500705 PMCID: PMC4602432 DOI: 10.1097/md.0000000000000219] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinical entity where tumor cell embolisms in pulmonary circulation induce thrombotic microangiopathy (TMA), respiratory failure, and subacute cor pulmonale.We describe 3 cases of PTTM that presented as the initial manifestation of metastatic gastric adenocarcinoma with TMA and pulmonary infiltrates.All 3 cases had similar clinical and laboratory features, which included moderate thrombocytopenia without renal failure, hemolysis with extremely high serum lactate dehydrogenase levels, leukoerythroblastosis in peripheral blood smear, altered coagulation tests, lymphadenopathies, and interstitial pulmonary infiltrates. All patients died within 2 weeks of diagnosis. Two cases were initially misdiagnosed as idiopathic thrombotic thrombocytopenic purpura and treated with plasma exchange with no response. One patient had bone marrow infiltration by malignant cells. Autopsies revealed PTTM associated with gastric disseminated adenocarcinoma (signet-ring cell type in 2 patients and poorly differentiated type in 1).PTTM should be considered in the differential diagnosis of patients with fulminant microangiopathic hemolytic anemia, such as atypical thrombotic thrombocytopenic purpura, mainly those with pulmonary infiltrates, disseminated intravascular coagulation, or Trousseau syndrome.
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Affiliation(s)
- Eukene Gainza
- From the Hematology Department (EG, MTC, JE); Medical Intensive Care Unit (SF, PC, JMN); Pathology Department (DM, JR); Internal Medicine Department (XB); and Hemotherapy-Hemostasis Department (AP), Hospital Clinic, Barcelona, Spain
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8
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Perrino CM, Dehner LP, Hartman ME, Agarwal A. Myelodysplastic syndrome with pulmonary tumor thrombotic microangiopathy in an 11-year-old male patient. Pediatr Dev Pathol 2014; 17:44-9. [PMID: 24099418 DOI: 10.2350/13-05-1339-cr.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myelodysplastic syndrome (MDS) and pulmonary tumor thrombotic microangiopathy (PTTM) are independently rare in the pediatric population. This report describes an 11-year-old male patient who initially presented with respiratory distress and cardiovascular collapse. A large left main pulmonary artery embolus and multiple, smaller pulmonary thromboemboli were widely dispersed throughout both lungs. Despite aggressive supportive care, he died within seven hours of admission. A complete postmortem examination was performed, leading to the diagnoses of primary MDS and microthrombi in the lungs, including the characteristic fibroproliferative lesions seen in PTTM. Individually, both conditions are extremely uncommon, and therefore the coincidence of these 2 conditions in a child is singularly unique.
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Affiliation(s)
- Carmen M Perrino
- 1 Department of Pathology and Immunology, Washington University, Campus Box 8118, 660 South Euclid Ave., St. Louis, MO 63110, USA
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9
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Fujishiro T, Shuto K, Shiratori T, Kono T, Akutsu Y, Uesato M, Hoshino I, Murakami K, Imanishi S, Tochigi T, Yonemori Y, Matsubara H. A case report of pulmonary tumor thrombotic microangiopathy (PTTM) caused by esophageal squamous cell carcinoma. Esophagus 2013; 10:247-251. [PMID: 24319402 PMCID: PMC3851705 DOI: 10.1007/s10388-013-0382-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 06/26/2013] [Indexed: 02/03/2023]
Abstract
A 67-year-old male was referred to our hospital after being diagnosed with esophageal squamous cell carcinoma of the middle thoracic esophagus. The clinical stage was T1b(sm)N4M1 cStage IVb, so he was admitted to our hospital for systemic chemotherapy. He had sustained fever and a dry cough. Chest computed tomography showed the presence of irregular shadows, and unidentified respiratory insufficiency had progressed. A transbronchial lung biopsy revealed a pulmonary artery tumor embolus of esophageal squamous cell carcinoma. He developed DIC and died of respiratory failure on the 19th hospital day. The postmortem autopsy detected pulmonary tumor thrombotic microangiopathy accompanied by esophageal squamous cell carcinoma.
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Affiliation(s)
- Takeshi Fujishiro
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Kiyohiko Shuto
- Department of Surgery, Teikyo University Chiba Medical Center, Ichihara, Japan
| | - Toru Shiratori
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Tuguaki Kono
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Yasunori Akutsu
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Masaya Uesato
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Isamu Hoshino
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Toru Tochigi
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
| | - Yoko Yonemori
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ward, Chiba, Chiba 260-8677 Japan
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10
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Abstract
Gastric adenocarcinoma is rare in childhood and often presents with disseminated malignancy at diagnosis due to aspecific symptoms leading to delay in diagnosis. A familial predisposition for gastrointestinal cancer is suggested for the development of this early-onset adenocarcinoma. We report the case of a 14-year-old girl with a familial history of colorectal, liver, and breast cancers affected by metastatic gastric adenocarcinoma, who first presented with thrombotic microangiopathy. Thrombotic microangiopathy as first clinical presentation of metastatic gastric cancer is an exceptional event in childhood and represents a challenge for pediatricians. Gastric adenocarcinoma should be suspected in young patients with a significant familial history and also in the absence of initial specific signs, so as to provide correct diagnosis and appropriate treatment.
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11
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Chinen K, Tokuda Y, Fujiwara M, Fujioka Y. Pulmonary tumor thrombotic microangiopathy in patients with gastric carcinoma: an analysis of 6 autopsy cases and review of the literature. Pathol Res Pract 2010; 206:682-9. [PMID: 20554399 DOI: 10.1016/j.prp.2010.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 05/01/2010] [Accepted: 05/10/2010] [Indexed: 11/18/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinicopathological entity causing severe pulmonary hypertension (PH). Its histological features include widespread tumor emboli of the small arteries and arterioles of the lung, associated with thrombus formation and fibrocellular and fibromuscular intimal proliferation. Although PTTM has drawn increased attention as a fatal complication of gastric carcinoma (GC), comprehensive studies are still lacking. In order to clarify clinical and pathological features of GC-induced PTTM, recent autopsy cases were analyzed with a review of the literature. Of 36 autopsy cases with GC, 6 (16.7%) were affected by PTTM. Four were male and 2 female, with a mean age of 72.7 years. Three patients presented with PTTM-related clinical manifestations and died of PTTM. They showed clear morphological evidence of PH. The other 3 patients had PTTM as an incidental finding irrespective of clinical manifestations or PH. No patient was diagnosed antemortem as PTTM. All PTTM cases were associated with advanced GC, with a histology of adenocarcinoma of poorly differentiated type (n=4) or signet-ring cell type (n=2). Expression of tissue factor and vascular endothelial growth factor was confirmed immunohistochemically in tumor cells in all cases. The results were all in line with previous studies. In addition, the current study revealed vascular lesions characteristic of PTTM morphology to be present exclusively in the lung. In conclusion, our study shows a 16.7% incidence of PTTM in GC patients, with half of them developing PH and dying of PTTM, confirming a clinical significance as a non-negligible lethal complication of GC. In addition to many known clinicopathological characteristics of PTTM, the current study pointed to some PTTM issues requiring clarification, including the pathogenesis of the exclusive pulmonary distribution of vascular lesions of PTTM. Since details remain to be elucidated, interdisciplinary research is a high priority with a close collaboration between pathologists and clinicians in order to overcome this lethal condition.
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Affiliation(s)
- Katsuya Chinen
- Department of Pathology, Kyorin University School of Medicine, Mitaka-city, Tokyo 181-8611, Japan.
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12
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Chinen K, Fujino T, Horita A, Sakamoto A, Fujioka Y. Pulmonary tumor thrombotic microangiopathy caused by an ovarian cancer expressing tissue factor and vascular endothelial growth factor. Pathol Res Pract 2009; 205:63-8. [DOI: 10.1016/j.prp.2008.08.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Babu RV, Romero A, Sharma G. A 39-year-old man with epigastric pain, intermittent chest pain, and progressive dyspnea. Chest 2008; 132:2012-5. [PMID: 18079237 DOI: 10.1378/chest.07-0878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Rajesh V Babu
- Division of Allergy, Pulmonary, Immunology, Critical Care, and Sleep Division, Department of Internal Medicine, University of Texas, Galveston, TX 77555-0561, USA
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14
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Miyano S, Izumi S, Takeda Y, Tokuhara M, Mochizuki M, Matsubara O, Kuwata H, Kobayashi N, Kudo K. Pulmonary tumor thrombotic microangiopathy. J Clin Oncol 2007; 25:597-9. [PMID: 17290069 DOI: 10.1200/jco.2006.09.0670] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shinsuke Miyano
- Department of Respiratory Medicine, International Medical Center of Japan, Shinjuku-Ku, Tokyo, Japan
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