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Kageyama S, Ohashi T, Kojima A. Pulmonary Tumor Thrombotic Microangiopathy Suspected to be COVID-19 Vaccine-Related Myocarditis: A Case Report. Cureus 2024; 16:e56803. [PMID: 38654790 PMCID: PMC11036115 DOI: 10.7759/cureus.56803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a very rare condition that can lead to acute severe pulmonary hypertension and circulatory failure. It is caused by tumor cell microvascular obstruction and is usually difficult to diagnose; in fact, it is often diagnosed after death. We report the case of a patient who experienced a sudden cardiac arrest and developed severe pulmonary hypertension two days after receiving the coronavirus disease (COVID-19) vaccine. The patient was initially diagnosed with vaccine-associated myocarditis, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) implantation with median sternotomy was performed. The patient survived for more than two weeks. PTTM was later diagnosed during a pathological autopsy.
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Affiliation(s)
- Soichiro Kageyama
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Takeki Ohashi
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
| | - Akinori Kojima
- Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai, JPN
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2
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Szabari MV, Ni C, Davila D, Viragh K. Pulmonary Arterial Tumor Embolism From Recurrent Metastatic Renal Cell Carcinoma on FDG PET/CT. Clin Nucl Med 2024; 49:160-161. [PMID: 37976430 DOI: 10.1097/rlu.0000000000004956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT A 55-year-old man with renal cell carcinoma extending into the renal vein/inferior vena cava (status post nephrectomy and inferior vena cava thrombectomy, pT3bN0M0), and perioperative pulmonary bland thromboembolism (resolved with 3-month of anticoagulation), followed by 3.5 years of complete remission, developed new incidental pulmonary arterial filling defects on a surveillance CT examination (asymptomatic, normal d -dimer, no deep vein thrombosis). Despite anticoagulation, the filling defects not only persisted but also demonstrated intense FDG activity on a restaging PET/CT performed 4 months later for new pulmonary oligometastasis. The FDG activity resolved after systemic immunotherapy, which suggested the retrospective diagnosis of pulmonary arterial tumor emboli, a rare finding.
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Affiliation(s)
- Margit V Szabari
- From the Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles
| | - Chiayi Ni
- Department of Radiology and Nuclear Medicine, Olive View-UCLA Medical Center, Sylmar, CA
| | - Diego Davila
- Department of Radiology and Nuclear Medicine, Olive View-UCLA Medical Center, Sylmar, CA
| | - Karoly Viragh
- Department of Radiology and Nuclear Medicine, Olive View-UCLA Medical Center, Sylmar, CA
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3
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Gil-García CA, Cueto-Robledo G, Gonzalez-Hermosillo LM, Alfaro-Cruz A, Roldan-Valadez E. Nonthrombotic Pulmonary Embolism Associated With Non-Hodgkin Lymphoma. Curr Probl Cardiol 2023; 48:102001. [PMID: 37506958 DOI: 10.1016/j.cpcardiol.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Nonthrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography to novel biomarkers, enabling the accurate and timely identification of NTPE. NTPE treatment options are diverse and patient-specific, requiring customized approaches to address varying embolic sources. Anticoagulation, embolus removal, and emerging interventions under study are discussed, providing clinicians with a comprehensive understanding of management strategies. This article uncovers the rare but captivating association between NTPE and non-Hodgkin lymphoma. Although rare, documented cases have sparked curiosity among researchers and medical practitioners. We explore potential pathophysiological connections, discussing challenges and considerations when encountering this unique scenario. In conclusion, this captivating review encapsulates the multifaceted realm of NTPE, covering its classification, diagnostics, and treatment modalities. Moreover, it presents a fascinating connection with non-Hodgkin lymphoma. This article offers a comprehensive and concise review of NTPE, guiding readers through its intricate classification, diagnostic approaches, and therapeutic interventions.
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Affiliation(s)
- Cesar-Alejandro Gil-García
- Faculty of Medicine, Autonomous University of Sinaloa, Los Mochis, Sinaloa, México; Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Ana Alfaro-Cruz
- Department of Surgical Pathology, General Hospital of Mexico, "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico; Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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4
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Bouchaala A, Khalek I, Kerrouani O, Mouine N, Lakhal Z, Benyass A. Pulmonary tumor embolism secondary to urothelial carcinoma of urinary bladder: case report and literature review. Egypt Heart J 2023; 75:93. [PMID: 38010529 PMCID: PMC10682423 DOI: 10.1186/s43044-023-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Tumor embolism is the least well-described cause of pulmonary embolism, taking into account the non-specificity of radiographic and nuclear imaging results, the necessity of anatomopathological evidence and the frequency of deep venous thrombosis in the course of solid tumors, suggesting thus thromboembolism. CASE PRESENTATION We report a rare case of urothelial carcinoma of the urinary bladder associated with persistent pulmonary embolism despite being on different anticoagulation regimens, the patient was ultimately found to have tumor thrombus in the pulmonary trunk secondary to tumoral extension. We provide a literature review as well about the diagnosis, evaluation and prognosis and of this rare clinical entity. CONCLUSIONS Our case highlights the importance of keeping this unusual etiology in mind, particularly when faced with pulmonary embolism occurring in the context of a solid tumor and the ineffectiveness of various anticoagulation protocols. Furthermore, it emphasizes the pivotal role of cytology in confirming diagnosis and guiding therapy.
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Affiliation(s)
- Abderrahmane Bouchaala
- Clinical Cardiology Department, Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Mohammed Belarabi Elalaoui Av., B.P.6203, 10000, Rabat, Morocco.
| | - Ihssane Khalek
- Clinical Cardiology Department, Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Mohammed Belarabi Elalaoui Av., B.P.6203, 10000, Rabat, Morocco
| | - Oualid Kerrouani
- Clinical Cardiology Department, Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Mohammed Belarabi Elalaoui Av., B.P.6203, 10000, Rabat, Morocco
| | - Najat Mouine
- Clinical Cardiology Department, Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Mohammed Belarabi Elalaoui Av., B.P.6203, 10000, Rabat, Morocco
| | - Zouhair Lakhal
- Cardiac Intensive Care Unit, Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Rabat, Morocco
| | - Aatif Benyass
- Head of Cardiology Center, Mohammed V Military Instruction Hospital of Rabat, Mohammed V University, Rabat, Morocco
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5
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Tan JE, Vishnu S, Singh D. Pulmonary tumor embolism in renal cell carcinoma detected by hybrid CT and F18-PSMA PET. Radiol Case Rep 2023; 18:4222-4225. [PMID: 37745764 PMCID: PMC10514386 DOI: 10.1016/j.radcr.2023.08.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 09/26/2023] Open
Abstract
We present the case of a 75-year-old female in which a pulmonary tumor embolism was detected incidentally on a prostate-specific membrane antigen positron emission tomography-computed tomography restaging scan. This occurred on the background of renal cell carcinoma in remission with pazopanib systemic therapy and a right nephrectomy 4 years prior. An avidity to prostate-specific membrane antigen in the superior lingula of the left upper lobe of the lung coupled with contrast-enhanced computed tomography findings found the lesion to be a tumor thrombus. This case serves to highlight the effectiveness of incorporating contrast-enhanced computed tomography with prostate-specific membrane antigen positron emission tomography and to consider the rare diagnosis of a pulmonary tumor embolism.
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Affiliation(s)
- Jared E. Tan
- The Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Sai Vishnu
- Qscan Radiology Clinics, Woolloongabba, Queensland, Australia
| | - Dalveer Singh
- Qscan Radiology Clinics, Woolloongabba, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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6
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Bayfield N, Wang E, Andrews D. Chronic inflammatory pulmonary artery lesion causing right pulmonary artery stenosis 15 years post Blalock-Taussig shunt ligation. BMJ Case Rep 2023; 16:e254103. [PMID: 37793846 PMCID: PMC10551977 DOI: 10.1136/bcr-2022-254103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Discrete central endovascular pulmonary arterial lesions raise clinical concern for malignancy such as primary pulmonary artery sarcoma. We present a case of a female in her late teens who had an obstructive mid right pulmonary artery lesion found on follow-up imaging 15 years after Tetralogy of Fallot repair. The lesion was in the vicinity of a previously ligated Blalock-Taussig shunt and causing right PA stenosis with delayed perfusion to the right lung, and a flow-related distal left PA aneurysm. The lesion was excised and confirmed histologically to be inflammatory in nature. Intraoperative microbiology demonstrated growth of the Kytococcus species, and she was managed with 6 weeks of intravenous antibiotics, with a full recovery.
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Affiliation(s)
| | - Edward Wang
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - David Andrews
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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7
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Tathireddy H, Rice D, Martens K, Shivakumar S, Shatzel J. Breaking down tumor thrombus: Current strategies for medical management. Thromb Res 2023; 230:144-151. [PMID: 37722206 PMCID: PMC11027429 DOI: 10.1016/j.thromres.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
Tumor thrombus, the intravascular extension of tumor into adjacent blood vessels, is frequently encountered in patients with renal cell carcinoma and hepatocellular carcinoma, and often involves the abdominal vasculature including the renal vein, portal vein, and the inferior vena cava. While a bland thrombus is composed of platelets and fibrin, in contrast, a tumor thrombus refers to an organized collection of tumor cells. Though oftentimes detected incidentally on imaging, tumor thrombus may have significant clinical implications and can be challenging to differentiate from bland thrombus. Additionally, the optimal management of tumor thrombus, including the use of anticoagulation, remains poorly described. This review summarizes common causes of tumor thrombus, as well as its impact on staging, prognosis, and treatment.
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Affiliation(s)
- Harsha Tathireddy
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA.
| | - Douglas Rice
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kylee Martens
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | | | - Joseph Shatzel
- Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA; Department of Biomedical Engineering, Oregon Health & Science University, OR, USA
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8
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Portillo-Romero A, Cuevas-Medina E, Santa Ana-Bayona MJ, Saenz-Ancira S. Acute pulmonary tumour embolism and right systolic dysfunction in a hidden intrahepatic cholangiocarcinoma: case report. Eur Heart J Case Rep 2023; 7:ytad291. [PMID: 37457051 PMCID: PMC10347672 DOI: 10.1093/ehjcr/ytad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Background Pulmonary tumour embolism is a rare entity that can arise from a wide variety of neoplasms. It can initially manifest as a pulmonary embolism with right heart failure and be refractory to thrombolytic therapy. Cholangiocarcinoma is a rare malignancy that arises from the epithelium of the biliary tree, representing 3% of all the gastrointestinal malignancies, being the intrahepatic cholangiocarcinoma the second most common liver tumour after hepatocellular carcinoma. Case summary This case regards a patient that presented to our centre with acute pulmonary embolism, deep vein thrombosis, and unrevealing previous medical history. Imaging studies revealed pulmonary embolism, an ovarian mass, and multiple hepatic hypodensities. Throughout the hospitalization, the patient's haemodynamic state and right heart failure worsened, eventually leading to multi-organ failure and death. Post-mortem evaluation revealed cholangiocarcinoma cells on the pulmonary arteries. Discussion Pulmonary tumour embolism is a rare pathology that can present with acute right heart failure. The diagnosis of occult cancer can be challenging, and the appropriate treatment for this entity remains an unexplored subject.
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Affiliation(s)
- Alejandra Portillo-Romero
- Department of Interventional Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No. 1, Colonia Seccion XVI, Tlalpan, Mexico City 14030, Mexico
| | - Eric Cuevas-Medina
- Department of Interventional Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano No. 1, Colonia Seccion XVI, Tlalpan, Mexico City 14030, Mexico
| | - Maria Jose Santa Ana-Bayona
- Mexican Faculty of Medicine, La Salle University, Las Fuentes 17, Tlalpan Centro I, Tlalpan, 14000 Ciudad de México, CDMX, Mexico
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9
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Costa FMD, Cerezoli MT, Medeiros AK. A rare combination: thrombotic and non-thrombotic pulmonary embolism. J Bras Pneumol 2023; 49:e20230074. [PMID: 37132739 PMCID: PMC10171271 DOI: 10.36416/1806-3756/e20230074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
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10
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Shahbaz Z, Inban P, Patel DK, Sayeed T, Tarimci B, Adewole IO, Nadia N, Dundi POR, Sajjad T, Khan A. Pulmonary Tumor Embolism Complicated by Metastatic Liver Carcinoma in Female With Primary Breast Carcinoma. Cureus 2023; 15:e37416. [PMID: 37182067 PMCID: PMC10174671 DOI: 10.7759/cureus.37416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
Pulmonary tumor embolism (PTE) is a rare phenomenon typically presenting as dyspnea in cancer patients. Primary pathophysiology is similar to the thromboembolic disease of the pulmonary vasculature, which involves large vessels to small arterioles. This phenomenon occurs mostly in lung, stomach, liver, and breast adenocarcinoma. The symptoms of hypoxemia and the signs of hemodynamic instability and high-resolution computed tomography (CT) scans, along with a histopathological examination, are essential to make a confirmatory diagnosis of pulmonary tumor embolism. However, treatment options to effectively treat pulmonary tumor embolus are limited and still under investigation. We present a rare case of pulmonary tumor embolism in a patient with metastatic liver carcinoma and its management in a female with primary breast carcinoma.
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Affiliation(s)
- Zanib Shahbaz
- Department of Research and Development, Windsor University School of Medicine, Chicago, USA
| | - Pugazhendi Inban
- Department of General Medicine, Government Medical College, Chennai, IND
| | - Dev K Patel
- Department of Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Tass Sayeed
- Department of Medicine, Windsor University School of Medicine, Chicago, USA
| | - Baris Tarimci
- Department of Internal Medicine, Ege University Faculty of Medicine, Izmir, TUR
| | - Idowu O Adewole
- Department of Medicine, All Saints University School of Medicine, Roseau, DMA
| | - Nabi Nadia
- Department of Obstetrics and Gynecology, Government Medical College, Srinagar, IND
| | - Prashant Obed R Dundi
- Department of General Practice, Karnataka Institute of Medical Sciences, Bangalore, IND
| | - Taha Sajjad
- Department of Medical Education, Mountain Vista Medical Center (MVMC), Phoenix, USA
| | - Aadil Khan
- Department of Internal Medicine, Lala Lajpat Rai (LLR) Hospital, Kanpur, IND
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11
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Itzhaki Ben Zadok O, Padera R, Nohria A. A Picture Is Worth 2,000 Words. JACC: CARDIOONCOLOGY 2023; 5:271-274. [PMID: 37144099 PMCID: PMC10152187 DOI: 10.1016/j.jaccao.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 03/09/2023]
Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Address for correspondence: Dr Osnat Itzhaki Ben Zadok, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts 02115, USA.
| | - Robert Padera
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Anju Nohria
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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12
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Fujita J, Hummel K, Xu Y. Pulmonary tumor thrombotic microangiopathy caused by metastatic ovarian high-grade serous carcinoma: a case report and literature review. Cardiovasc Pathol 2023:107526. [PMID: 36781067 DOI: 10.1016/j.carpath.2023.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare entity with poor prognosis, and often diagnosed postmortem. PTTM is resulting from tumor emboli induced activation of coagulation cascade, fibrin clot formation and fibrocellular intimal proliferation in pulmonary microvasculature. CASE The patient was a 65-year-old female, with past medical history of ovarian high-grade serous carcinoma, presented with chest pain and shortness of breath. The chest computed tomography (CT) revealed innumerable new lung nodules as well as small hazy and patchy opacities compared to the chest CT 2 months before current presentation. She developed progressive respiratory failure and expired. A lung-restricted autopsy showed diffuse subcentimetric nodules in bilateral lungs grossly. Microscopic examination revealed the lung parenchyma demonstrated numerous tumor emboli consisting of pleomorphic tumor cells with varying degrees of fibrin deposition and fibrocellular intimal proliferation in the pulmonary arterioles, small arteries, and capillaries in the alveolar septa. Immunohistochemistry confirmed the ovarian origin of the tumor cells. The findings were consistent with PTTM secondary to metastasis of ovarian high-grade serous carcinoma. Literature review of PTTM caused by ovarian cancer was conducted. CONCLUSION PTTM is a fatal entity with rare association with primary ovarian malignancy. This case study demonstrates the clinicopathological features of PTTM associated with high-grade serous carcinoma, and it will be the second case of PTTM with this association in the literature.
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Affiliation(s)
- Jun Fujita
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Kelsey Hummel
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Ya Xu
- Department of Pathology & Immunology, Baylor College of Medicine, Department of Pathology, Ben Taub General Hospital, Harris Health System, Houston, TX, USA.
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13
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Donahoe LL, Patel S, Tole S, Zorzi AP, Huang L, Honjo O, de Perrot M. Osteosarcoma emboli presenting as chronic thromboembolic pulmonary hypertension in a child. Pediatr Hematol Oncol 2023; 40:65-69. [PMID: 36701380 DOI: 10.1080/08880018.2022.2053767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A 13-year-old girl presented with hypoxemia during adjuvant chemotherapy for an osteosarcoma of the left distal femur. She underwent an amputation complicated by a post-operative pulmonary embolism (PE). Three months post-operatively, she was admitted to hospital with severe hypoxemia and diagnosed with pulmonary hypertension on echocardiogram in the context of extensive bilateral PE on computed tomography. She was planned for elective pulmonary thromboendarterectomy, but rapidly deteriorated requiring emergent surgery. At the time of surgery, she was found to have extensive tumor emboli throughout both pulmonary arteries. She recovered well post-operatively but died 2 months later from progressive disease.
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Affiliation(s)
- Laura L Donahoe
- Toronto CTEPH Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Serina Patel
- Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Soumitra Tole
- Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Alexandra P Zorzi
- Children's Hospital, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Lennox Huang
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Osami Honjo
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Toronto CTEPH Program, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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14
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Khanna L, Vargas D, Menias C‘C, Katabathina V. Oncologic Emergencies in the Chest, Abdomen, and Pelvis. Radiol Clin North Am 2023; 61:91-110. [DOI: 10.1016/j.rcl.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Elajami MK, Mansour E, Bahmad HF, Chaaya G, DeBeer S, Poppiti R, Omarzai Y. Renal Cell Carcinoma Presenting as Syncope due to Saddle Pulmonary Tumor Embolism. Diseases 2022; 10:diseases10040119. [PMID: 36547205 PMCID: PMC9778154 DOI: 10.3390/diseases10040119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/10/2022] [Accepted: 11/30/2022] [Indexed: 12/11/2022] Open
Abstract
Pulmonary embolism (PE) is defined as the obstruction of the pulmonary artery or one of its branches by a blood clot, tumor, air, or fat emboli originating elsewhere in the body. A saddle PE occurs when the obstruction affects the bifurcation of the main pulmonary artery trunk. We present a case of a 46-year-old man who presented to our hospital due to an episode of syncope. Computed tomography angiography (CTA) of the chest showed extensive PE and abdominal CT scan showed a large 8 cm left renal mass with inferior vena cava (IVC) thrombus. Emergent embolectomy, left total nephrectomy, and IVC tumor removal were performed yielding the diagnosis of clear cell renal cell carcinoma (RCC). Interestingly, our patient did not experience any symptoms related to his RCC until the diagnosis of PE due to syncope, and the asymptomatic tumor was found out to be the possible cause of this PE due to the presence of tumor cells constituting the tumor embolus. It is thus recommended to improve the early screening process for RCC. Besides, clinicians should pay attention to patients presenting with uncharacteristic symptoms of RCC who might present with symptoms of saddle PE.
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Affiliation(s)
- Mohamad K. Elajami
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Ephraim Mansour
- Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Hisham F. Bahmad
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Correspondence: or ; Tel.: +1-305-674-2277
| | - Gerard Chaaya
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Steven DeBeer
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL 33140, USA
| | - Robert Poppiti
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
| | - Yumna Omarzai
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
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16
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CARREIRA M, LISBOA-GONÇALVES P, MATOS MI, FLORES L, CUNHA F, VON HAFE P. Relapsing uterine adenosarcoma presenting as pulmonary hypertension. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Clayton‐Chubb D, Chan E, Schneider D, Riley B, Dwyer J. Undiagnosed gastric adenocarcinoma causing progressive respiratory failure. JGH Open 2022; 6:730-731. [PMID: 36262542 PMCID: PMC9575325 DOI: 10.1002/jgh3.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/19/2022] [Accepted: 08/13/2022] [Indexed: 11/11/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare manifestation of malignancy. Pulmonary tumor emboli and associated fibrous intimal hyperplasia cause widespread pulmonary vascular stenosis/occlusion, which in turn increase pulmonary vascular resistance and lead to pulmonary hypertension. Gastric cancer is the most common underlying malignancy that leads to PTTM, and patients may present with dyspnea or other features of pulmonary hypertension prior to the diagnosis of cancer. In this short report, we describe a case of pulmonary hypertension due to gastric cancer associated PTTM. Endoscopic and histopathologic findings are shown, and a brief review of the literature is presented.
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Affiliation(s)
- Daniel Clayton‐Chubb
- Department of Gastroenterology Alfred Health Melbourne Victoria Australia
- Department of Medicine, Central Clinical School Monash University Melbourne Victoria Australia
| | - Ewan Chan
- Department of Anatomical Pathology Alfred Health Melbourne Victoria Australia
| | - Daniel Schneider
- Department of Gastroenterology Alfred Health Melbourne Victoria Australia
| | - Brooke Riley
- Intensive Care Unit Alfred Health Melbourne Victoria Australia
| | - Jeremy Dwyer
- Department of Gastroenterology Alfred Health Melbourne Victoria Australia
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18
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Lashari BH, Kumaran M, Aneja A, Bull T, Rali P. Beyond Clots in the Pulmonary Circulation: Pulmonary Artery Tumors Mimicking Pulmonary Embolism. Chest 2022; 161:1642-1650. [PMID: 35041833 DOI: 10.1016/j.chest.2022.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/02/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022] Open
Abstract
Pulmonary embolism (PE) is the most common filling defect seen on CT scan pulmonary angiography. Pulmonary artery (PA) tumors can mimic PE on imaging and clinical presentation. One classic feature of tumors is failure to improve on anticoagulation. PA tumors, particularly malignant ones, have radically different treatments and usually have a grim prognosis. Thus, it is essential that PA tumors, when suspected, receive an expedited confirmatory diagnosis followed by multidisciplinary treatment at an expert center. In this review, we present clinical, imaging, and histopathologic features of benign and malignant PA tumors, emphasizing differentiating features from PE. We also describe available diagnostic and treatment methods for PA tumors.
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Affiliation(s)
- Bilal Haider Lashari
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA.
| | - Maruti Kumaran
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Amandeep Aneja
- Department of Pathology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Todd Bull
- Department of Medicine, Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
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19
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Katano T, Tsuzuki T, Numanami H, Sassa N, Kato T, Kubo A, Ito S. A case of renal cell carcinoma with microscopic pulmonary tumor embolism proven by surgical lung biopsy. Respir Med Case Rep 2022; 39:101716. [PMID: 35958348 PMCID: PMC9358455 DOI: 10.1016/j.rmcr.2022.101716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/05/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pulmonary tumor embolism (PTE) is difficult to diagnose before death. We report the case of a 75-year-old man with microscopic PTE of renal cell carcinoma who was diagnosed by surgical lung biopsy. He visited our hospital because of dyspnea on exertion. Chest computed tomography (CT) showed multiple micronodules and ground glass opacities. Steroid therapy was started as therapeutic diagnosis for IgG4-related pulmonary disease. However, he was admitted our hospital due to progressive respiratory failure. Pathological findings of a lung biopsy obtained by video-assisted thoracic surgery showed PTE of renal cell carcinoma without embolization of large pulmonary arteries. He received palliative medicine and died four months after the surgical lung biopsy. In cases of multiple micronodules in chest CT findings and worsened respiratory symptoms, PTE should be considered in the differential diagnosis.
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20
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Rajdev K, Madan U, McMillan S, Wilson K, Fisher K, Hein A, Patil A, Bista S, Hershberger D, Boer B. Pulmonary Tumor Embolism and Pulmonary Tumor Thrombotic Microangiopathy Causing Rapidly Progressive Respiratory Failure: A Case Series. J Investig Med High Impact Case Rep 2022; 10:23247096221086453. [PMID: 35313765 PMCID: PMC8943465 DOI: 10.1177/23247096221086453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/04/2022] Open
Abstract
Pulmonary tumor embolism (PTE) and pulmonary tumor thrombotic microangiopathy (PTTM) are rare etiologies for rapidly progressive dyspnea in the setting of undiagnosed metastatic cancer. They occur most frequently in association with adenocarcinomas, with PTE being most frequently associated with hepatocellular carcinoma and PTTM being most commonly reported with gastric adenocarcinoma. Pulmonary tumor embolism and PTTM appear to be a disease spectrum where PTTM represents an advanced form of PTE. Pulmonary tumor embolism and PTTM are mostly identified postmortem during autopsy as the antemortem diagnosis remains a clinical challenge due to the rapidly progressive nature of these rare diseases. We report 2 cases of rapidly progressive respiratory failure leading to death, due to tumoral pulmonary hypertension resulting from PTE and PTTM, diagnosed postmortem. Both of the patients were middle-aged females, nonsmokers, and had a gastrointestinal source of their primary malignancy.
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Affiliation(s)
| | - Ujjwal Madan
- University College of Medical
Sciences, Delhi, India
| | | | - Kyle Wilson
- University of Nebraska Medical
Center, Omaha, USA
| | - Kurt Fisher
- University of Nebraska Medical
Center, Omaha, USA
| | - Ashley Hein
- University of Nebraska Medical
Center, Omaha, USA
| | - Amol Patil
- University of Nebraska Medical
Center, Omaha, USA
| | - Sabin Bista
- University of Nebraska Medical
Center, Omaha, USA
| | | | - Brian Boer
- University of Nebraska Medical
Center, Omaha, USA
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21
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Alsaggaf M, Bawa AS, Khosla R. An Autopsy Case of Pulmonary Tumor Emboli Due to Metastatic Squamous Cell Carcinoma. Cureus 2021; 13:e19506. [PMID: 34912643 PMCID: PMC8664405 DOI: 10.7759/cureus.19506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
A 74-year-old man with chronic obstructive pulmonary disease on home oxygen and coronary artery disease was transferred from an outside facility to obtain an inguinal lymph node biopsy to rule out malignancy. He underwent an uncomplicated procedure and was discharged the same day. While waiting for transportation, he had sudden-onset dyspnea and collapsed. After resuscitation, patient had return of spontaneous circulation and was admitted but was provided comfort care and soon expired. Autopsy showed metastatic squamous cell carcinoma with multiple bilateral tumor emboli. Pulmonary tumor embolism is a rare cause of dyspnea in cancer population. Most of the cases are diagnosed with autopsy after sudden death; however, few cases have been reported antemortem. Tumor embolism is rare and difficult to diagnose without an autopsy with a poor outcome.
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Affiliation(s)
- Mohammed Alsaggaf
- Pulmonary and Critical Care Medicine, George Washington University Hospital, Washington DC, USA
| | - Amandeep S Bawa
- Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington DC, USA
| | - Rahul Khosla
- Pulmonary and Critical Care Medicine, Veterans Affairs Medical Center, Washington DC, USA
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22
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Kamakura M, Okazaki A, Ito K, Kin F, Miyajima K, Takashima Y, Watanabe T, Kawaguchi Y, Wakabayashi Y, Asano M, Maekawa Y. Concomitant Pulmonary and Cerebral Tumor Embolism and Intracardiac Metastasis from Bladder Cancer. Intern Med 2021; 60:3749-3753. [PMID: 34120999 PMCID: PMC8710365 DOI: 10.2169/internalmedicine.6765-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 82-year-old woman with a history of bladder cancer presented with dyspnea and loss of consciousness. Contrast-enhanced computed tomography revealed pulmonary embolism, and emergency thrombus aspiration therapy was performed, but the thrombus was not aspirated. Echocardiography showed mobile masses in the heart and a right-to-left shunt due to a patent foramen ovale (PFO). Magnetic resonance imaging showed multiple cerebral infarctions. Surgical thrombectomy and PFO closure were performed, and the patient was diagnosed with intracardiac metastasis of bladder cancer based on intraoperative histopathology. This is a rare case of concomitant pulmonary and cerebral tumor embolism and intracardiac metastasis from bladder cancer.
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Affiliation(s)
| | - Ayako Okazaki
- Department of Cardiology, Seirei Mikatahara General Hospital, Japan
| | - Kazuki Ito
- Department of Cardiology, Seirei Mikatahara General Hospital, Japan
| | - Fumihiko Kin
- Department of Cardiology, Seirei Mikatahara General Hospital, Japan
| | - Keisuke Miyajima
- Department of Cardiology, Seirei Mikatahara General Hospital, Japan
| | - Yasuyo Takashima
- Department of Cardiology, Seirei Mikatahara General Hospital, Japan
| | | | | | | | - Mitsuru Asano
- Department of Cardiac Surgery, Seirei Mikatahara General Hospital, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Japan
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23
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Roderburg C, Loosen SH, Hippe HJ, Luedde T, Kostev K, Luedde M. Pulmonary hypertension is associated with an increased incidence of cancer diagnoses. Pulm Circ 2021; 12:e12000. [PMID: 35783034 PMCID: PMC9235867 DOI: 10.1002/pul2.12000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/20/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
Pulmonary hypertension (PH) is a complex disease with increasing global incidence that eventually leads to right ventricular failure and is associated with a poor prognosis. The importance of noncardiac comorbidities in disease progression and prognosis has gained increasing recognition in recent years. In the present study, we investigated a potential association between PH and cancer in an outpatient cohort in Germany. Using the IQVIA Disease Analyzer database, we identified a total of 11,109 patients with PH and a propensity score matched cohort of equal size without PH who received medical treatment between 2005 and 2019. Logistic regression models were used to evaluate the potential association between PH and cancer. Within the 10‐year observation period, the incidence of cancer was significantly higher in PH patients than non‐PH patients (23.2% vs. 8.5%, log‐rank p < 0.001). Importantly, this association was observed for both male (HR = 1.24, p = 0.002) and female (HR = 1.37, p < 0.001) patients, and was most pronounced in patients >80 years (HR = 1.50, p < 0.001). In terms of a specific tumor site, we found a significant association for respiratory organ cancer (HR = 1.60, p = 0.007) and skin cancer (HR = 1.48, p < 0.001). Our study provides strong evidence that PH is associated with an increased incidence of cancer. This finding should help raise awareness of this important comorbidity and could trigger specific screening programs in patients with PH.
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Affiliation(s)
- Christoph Roderburg
- Clinic for Gastroenterology, Hepatology and Infectious Diseases; University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | - Sven H Loosen
- Clinic for Gastroenterology, Hepatology and Infectious Diseases; University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | | | - Tom Luedde
- Clinic for Gastroenterology, Hepatology and Infectious Diseases; University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf; Düsseldorf Germany
| | | | - Mark Luedde
- Christian-Albrechts-University of Kiel; Germany
- Cardiology Joint Practice Bremerhaven; Germany
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24
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Pulmonary tumor embolism from breast cancer diagnosed by selective aspiration cytology using a Swan-Ganz catheter. Respir Med Case Rep 2021; 34:101527. [PMID: 34692400 PMCID: PMC8512626 DOI: 10.1016/j.rmcr.2021.101527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 12/25/2022] Open
Abstract
We describe a case of pulmonary tumor embolism (PTE) from breast cancer diagnosed by selective aspiration cytology using a Swan-Ganz catheter. A 60-year-old woman was referred to Hamanomachi Hospital because of increased levels of tumor markers. The patient complained only of slight exertional dyspnea and a dry cough. Due to breast cancer, she had undergone a mastectomy followed by radiation and chemotherapy one year earlier. Positron emission tomography scanning with CT images revealed no evidence of malignancy. Repeated chest CT images showed emerging wedge-shaped nodules in the subpleural zones of the left lower lobe with diffuse ground-glass opacities in the bilateral lower lobes. The D-dimer level was negative. Pulmonary perfusion scintigraphy showed multiple small wedge-shaped defect areas on the peripheral sides of the bilateral lungs. Suspecting PTE, we performed selective aspiration cytology from the left pulmonary arteries. Cancer cells were detected from selected branches of left A8 and A9. Morphology and immunostaining led to a final diagnosis of PTE of recurrent breast cancer. Pulmonary embolism of cancer is a progressive, fatal condition with challenging diagnosis. Selective aspiration cytology with a Swan-Ganz catheter is a useful, less invasive option in patients with suspected PTE.
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25
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He X, Anthony DC, Catoni Z, Cao W. Pulmonary tumor embolism: A retrospective study over a 30-year period. PLoS One 2021; 16:e0255917. [PMID: 34379693 PMCID: PMC8357121 DOI: 10.1371/journal.pone.0255917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis. Methods We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival. Results We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240). Conclusions The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.
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Affiliation(s)
- Xin He
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Pathology, University of Massachusetts School of Medicine, Worcester, MA, United States of America
| | - Douglas C. Anthony
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Neurology, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Zulmira Catoni
- Human Information Management, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Weibiao Cao
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- * E-mail:
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26
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Annangi S, Snyder D, Smith K. Curious Case of Unexplained Dyspnea With Malignancy. Chest 2021; 158:e251-e255. [PMID: 33160547 DOI: 10.1016/j.chest.2020.03.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/06/2020] [Accepted: 03/07/2020] [Indexed: 10/23/2022] Open
Abstract
CASE PRESENTATION A 48-year-old female never smoker with hypothyroidism and no significant prior respiratory complaints presented with 1 month of gradually worsening dyspnea on exertion. She denied any associated fevers, chills, weight loss, chest pain, productive cough, hemoptysis, or sick contacts. She was recently diagnosed with stage IV triple negative adenocarcinoma of the breast and was yet to receive chemotherapy.
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Affiliation(s)
- Srinadh Annangi
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Daniel Snyder
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, KY
| | - Kevin Smith
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Kentucky College of Medicine, Lexington, KY.
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27
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Gimbel IA, Mulder FI, Bosch FTM, Freund JE, Guman N, van Es N, Kamphuisen PW, Büller HR, Middeldorp S. Pulmonary embolism at autopsy in cancer patients. J Thromb Haemost 2021; 19:1228-1235. [PMID: 33501757 PMCID: PMC8252008 DOI: 10.1111/jth.15250] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is a potentially fatal disease, but data on the incidence of fatal PE in cancer patients are scant. OBJECTIVE We sought to estimate the proportion of cancer patients with PE at autopsy. METHODS For this retrospective cohort study, all autopsy reports of cancer patients were retrieved from PALGA: Dutch Pathology Registry and used for data extraction. The primary outcome was PE at time of autopsy, defined as any clot obstructing a pulmonary artery. The secondary outcome was venous thromboembolism, defined as the composite of thrombotic PE, deep vein thrombosis, splanchnic vein thrombosis, or internal jugular vein thrombosis. RESULTS A total of 9571 cancer patients were included. In 1191 (12.4%; 95% confidence interval [CI], 11.8-13.1) patients, one or more PE events were observed at autopsy, of whom 1074 (90.2%) had a thrombotic embolism, 168 (14.1%) a tumor embolism, 9 (0.8%) a septic embolism, 7 (0.6%) a fat tissue embolism, and 3 (0.3%) a bone marrow embolism. Among patients with PE for whom the cause of death was specified in the autopsy report, death was considered PE-related in 642 patients (66.7%), which was 6.7% of the total study population. Venous thromboembolism was observed in 1223 (12.8%; 95% CI, 12.1-13.5) patients. CONCLUSION The proportion of PE in cancer patients at autopsy is substantial. Although the study population is not representative for the total cancer population, it suggests that PE is an important disease complication in cancer patients.
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Affiliation(s)
- Inge A. Gimbel
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frits I. Mulder
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Floris T. M. Bosch
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Jan Erik Freund
- Department of PathologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Noori Guman
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Nick van Es
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pieter W. Kamphuisen
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Internal MedicineTergooi HospitalHilversumThe Netherlands
| | - Harry R. Büller
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Saskia Middeldorp
- Department of Vascular MedicineAmsterdam Cardiovascular ScienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
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28
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Kirkpatrick EC. Pulmonary Hypertension as a Complication of Pediatric Cancer. Glob Pediatr Health 2021; 8:2333794X211009094. [PMID: 33889681 PMCID: PMC8040614 DOI: 10.1177/2333794x211009094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/13/2021] [Indexed: 11/16/2022] Open
Abstract
Pediatric cancer is a life threatening disease known to create multi-organ complications that further compromise medical management affecting patient morbidity and mortality. Pulmonary hypertension (PH) is becoming more recognized as a complication of cancer and its therapies but has not been well characterized in pediatrics. Cancer pathophysiology can be uniquely set up to promote pulmonary vascular injury and remodeling that is similar to PH patients without cancer. This highlights the need to evaluate for PH clinically and with routine testing such as echocardiography during the course of a patient's care even into adulthood. This review article will discuss the direct, indirect and therapy related aspects of cancer which can promote PH in these patients. This understanding is essential to target effective treatment options in a potentially fatal complication. Diagnostic and treatment algorithms are presented in relation to the most recent pediatric PH management guidelines.
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29
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The diagnostic challenge in pulmonary tumour embolism in cancer: a case report and literature review. Contemp Oncol (Pozn) 2021; 24:258-262. [PMID: 33531874 PMCID: PMC7836275 DOI: 10.5114/wo.2020.102631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary tumour embolism is a rare condition without specific symptoms or pathognomonic features. Pulmonary tumour embolism can occur as the first manifestation of cancer, but because of diagnostic difficulties, it is often wrongly recognised as a more common cardiopulmonary disease. We present a case of a 46-year-old Caucasian male with no prior malignancy diagnosis, admitted because of progressing dyspnoea and cough. Based on radiological and clinical presentations, sarcoidosis, silicosis and lymphangitic carcinomatosis were considered in the differential diagnosis. Histopathological analysis of lung biopsy revealed that multiple emboli of atypical epithelial cells found in the pulmonary vessels were of gastrointestinal origin. Further pathological examination of the gastric biopsy led to the final diagnosis of the signet-ring cells gastric adenocarcinoma. The patient was referred for chemotherapy. After a short-term partial remission, he died within two months after the final diagnosis. The presented case illustrates challenges posed by the diagnostic process of pulmonary tumour embolism.
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30
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Chong T, Park J, Aslam HM, Ansari S, Wallach SL. Pulmonary Tumor Embolism: A Rare Cause of Acute Pulmonary Hypertension. Cureus 2020; 12:e11877. [PMID: 33415030 PMCID: PMC7781770 DOI: 10.7759/cureus.11877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A rare cause of acute decompensated pulmonary hypertension is pulmonary tumor embolism (PTE), which is an uncommon complication of advanced lung malignancy. Patients diagnosed with PTE typically have a poor prognosis, and so patients with advanced lung tumors who present with signs of right heart failure and respiratory support should be evaluated for PTE. We present a case of a 54-year-old Hispanic female who initially presented with a one-month history of dysphagia, who was found to have acute pulmonary hypertension secondary to invasion of the pulmonary arteries by lung adenocarcinoma.
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Affiliation(s)
- Timothy Chong
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
| | - Joseph Park
- Internal Medicine, Drexel College of Medicine, Philadelphia, USA
| | - Hafiz M Aslam
- Hematology and Medical Oncology, East Carolina University, Greenville, USA
| | - Shahryar Ansari
- Internal Medicine, St. Francis Medical Center, Seton Hall University, Trenton, USA
| | - Sara L Wallach
- Internal Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Trenton, USA
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31
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Vaideeswar P, Aswani Y, Damani S, Singaravel S. Pulmonary microvascular metastases in cervical carcinoma: A case series. J Postgrad Med 2020; 66:155-158. [PMID: 32675452 PMCID: PMC7542055 DOI: 10.4103/jpgm.jpgm_243_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pulmonary microvascular tumor embolism (PMTE), pulmonary tumor thrombotic microangiopathy (PTTM), and lymphangitis carcinomatosis (LC) have an intricate pathophysiology and usually occur with cancers of breast, stomach, and lung. Microvascular pulmonary metastases attributable to cervical cancer are a rarity. Clinical presentation and autopsy findings of patients with microvascular pulmonary metastases in cervical cancers were studied with a review of literature. Four patients (mean age of 55.5 years) with carcinoma cervix showed microvascular metastases. Three of whom presented with respiratory symptoms, and the fourth case was unresponsive on presentation. Each patient succumbed to their illness shortly after admission. Autopsy examination performed on each patient depicted varying combination of PMTE, PTTM, and LC, all with squamous histology. This case series highlights the rare association of carcinoma cervix with the aforementioned microvascular phenomena. Besides, it underscores the sequential mechanism of occurrence of microvascular pulmonary metastasis and the associated guarded prognosis.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
| | - Y Aswani
- Department of Radiology, Seth GS Medical College, Mumbai, Maharashtra, India
| | - S Damani
- Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
| | - S Singaravel
- Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
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Lopez-Garcia CA, Garcia-Hernandez I, López-Sotomayor DM, Martínez-Amador C, Rodríguez-Prado A, Esteban-Zubero E, Alatorre-Jimenez MA, Dono A, Pérez-Saucedo JE. Metastatic colorectal micropapillary carcinoma presenting as lymphangitic lung carcinomatosis. Clin J Gastroenterol 2020; 14:193-197. [PMID: 33040282 DOI: 10.1007/s12328-020-01258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
Pulmonary lymphangitic carcinomatosis denotes the infiltration of tumor cells into the lung parenchymal lymphatic channels. Breast, lung, stomach, and colon adenocarcinoma are the most common origin of this invasion pattern. The micropapillary variant of colorectal adenocarcinoma has a high rate of lymph node metastases and poor overall survival. A 49 year-old man with a 6 months history of persistent cough and a relevant occupational chemical exposure had a computed tomography that showed bilateral interstitial lung infiltrates. The lung biopsy demonstrated a micropapillary adenocarcinoma with diffusely obstruction of the lung parenchymal lymphatics. The immunohistochemistry confirmed a colorectal origin. The colonoscopy evidenced a mass with identical morphology. Colorectal micropapillary carcinoma with metastatic lung lymphangitic carcinomatosis can occur, as a persistent cough, as presenting symptom in extraordinarily rare cases. To the best of our knowledge, this is the first case of an alive patient with colorectal metastatic micropapillary carcinoma presenting with lymphangitic lung carcinomatosis.
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Affiliation(s)
- Carlos A Lopez-Garcia
- Tecnologico de Monterrey, Hospital San Jose, Tec Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Irean Garcia-Hernandez
- Tecnologico de Monterrey, Hospital San Jose, Tec Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Dulce María López-Sotomayor
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Claudia Martínez-Amador
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Alejandra Rodríguez-Prado
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México
| | - Eduardo Esteban-Zubero
- Department of Emergency, Hospital San Pedro, Calle Piqueras, 98, 26006, Logroño, La Rioja, Spain
| | | | - Antonio Dono
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center At Houston, Medical School, 6431 Fannin, Suite 7.146 Houston, Houston, TX, 77030, USA
| | - José Eduardo Pérez-Saucedo
- Tecnologico de Monterrey, Hospital San Jose, Tec Salud, Av. Morones Prieto #3000 Pte, Col. Los Doctores, CP 64710, Monterrey, Nuevo León, México.
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Yang X, Wang L, Lin L, Liu X. Elevated Pulmonary Artery Systolic Pressure is Associated with Poor Survival of Patients with Non-Small Cell Lung Cancer. Cancer Manag Res 2020; 12:6363-6371. [PMID: 32821155 PMCID: PMC7419633 DOI: 10.2147/cmar.s260857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Pulmonary hypertension (PH) is an important comorbidity of lung cancer, PH in lung cancer patients is gradually gaining interest because of its apparent high prevalence, but the impact of PH on the outcomes of lung cancer remains uncertain and had rarely been discussed. We aimed to evaluate the prevalence, determinants and prognosis value of elevated pulmonary artery systolic pressure (PASP) in non-small cell lung cancer patients. Patients and Methods In this retrospective study, subjects with a new and pathological confirmed diagnosis of lung cancer were enrolled. All patients underwent transthoracic echocardiography before received treatment. Pulmonary artery systolic pressure was measured by transthoracic echocardiography. Lung cancer subtypes were categorized by WHO classification of lung tumors. Hazard ratios (HR) were estimated by using Cox regression models. Results Among 612 non-small cell lung cancer (NSCLC) patients, 19.8% coexisted with PH. After adjustment for age, symptom, coagulation disorders, lymph node metastasis, distant metastasis, histological type, clinical stage, PASP ≥35mmHg was significantly associated with the decreased overall survival (OS) of NSCLC (P= 0.028). Moreover, PASP ≥45mmHg was an independent predictor for perioperative death. Independent factors of comorbid elevated PASP were age, the presence of intrapulmonary metastasis and coagulation disorders. Conclusion These findings suggest that PASP is an independent prognostic risk factor for NSCLC patients. Main determinants of elevated PASP are age, the presence of intrapulmonary metastasis and coagulation disorders.
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Affiliation(s)
- Xue Yang
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, People's Republic of China
| | - Lina Wang
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, People's Republic of China
| | - Lianjun Lin
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, People's Republic of China
| | - Xinmin Liu
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, People's Republic of China
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Petnak T, Suwatanapongched T, Klaisuban W, Nitiwarangkul C, Pornsuriyasak P. Initial diagnosis and successful treatment of pulmonary tumor embolism manifesting as the first clinical sign of prostatic adenocarcinoma. Respir Med Case Rep 2020; 31:101163. [PMID: 32714825 PMCID: PMC7378679 DOI: 10.1016/j.rmcr.2020.101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
Although pulmonary tumor embolism (PTE) is a well-recognized end-stage form of pulmonary metastases at postmortem examination, the entity is rarely the first clinical sign of prostate cancer. Diagnosis of this condition in patients who have no previous history of malignancy is a challenge. Herein, we reported a 79-year-old man presented with progressive, unexplained dyspnea on exertion. Microscopic PTE coinciding with pulmonary lymphangitic carcinomatosis were readily recognized based on the presence of multifocal dilatation and beading of the peripheral pulmonary arteries with thickening of the bronchial walls and interlobular septa on the initial thin-section chest CT images. Pathologic examination of the transbronchial lung biopsy specimen revealed tumor emboli occluding both the small muscular pulmonary arteries and lymphatic vessels. These tumor cells were positive for prostatic specific antigen on immunohistochemical staining. The final diagnosis of prostatic adenocarcinoma was confirmed. Remarkable clinical and radiographic improvement was achieved following bilateral orchiectomies and anti-androgen treatment. Pulmonary tumor embolism (PTE) can be the first clinical sign of advanced prostatic adenocarcinoma. CT findings of dilated, beaded peripheral pulmonary arteries should raise a concern of microscopic PTE. Dilated, beaded pulmonary arteries should not be mistaken for tree-in-bud opacities caused by bronchiolar disease on CT. Prostate cancer should always be considered in the differential diagnosis of adenocarcinoma of unknown origin in men.
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Affiliation(s)
- Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thitiporn Suwatanapongched
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Corresponding author. Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. Address: 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Wipawi Klaisuban
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chayanin Nitiwarangkul
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapaporn Pornsuriyasak
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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35
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Waki Y, Nobeyama Y, Ogawa T, Fukuchi O, Fukazawa N, Asahina A. Case of extramammary Paget's disease causing pulmonary tumor embolism. J Dermatol 2020; 47:e133-e134. [PMID: 32056268 DOI: 10.1111/1346-8138.15267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yuma Waki
- Department of Dermatology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Yoshimasa Nobeyama
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomohiro Ogawa
- Department of Dermatology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Osamu Fukuchi
- Department of Dermatology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Nei Fukazawa
- Department of Pathology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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Aceto N. Bring along your friends: Homotypic and heterotypic circulating tumor cell clustering to accelerate metastasis. Biomed J 2020; 43:18-23. [PMID: 32200952 PMCID: PMC7090281 DOI: 10.1016/j.bj.2019.11.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/01/2019] [Accepted: 11/07/2019] [Indexed: 11/23/2022] Open
Abstract
Metastasis formation is a hallmark of invasive cancers and it is achieved through the shedding of circulating tumor cells (CTCs) from the primary site into the blood circulation. There, CTCs are found as single cells or as multicellular clusters, with clusters carrying an elevated ability to survive within the bloodstream and initiate new metastatic lesions at distant sites. Clusters of CTCs include homotypic clusters made of cancer cells only, as well as heterotypic clusters that incorporate stromal or immune cells along with cancer cells. Both homotypic and heterotypic CTC clusters are characterized by a high metastasis-forming capability, high proliferation rate and by distinct molecular features compared to single CTCs, and their presence in the peripheral circulation of cancer patients is generally associated with a poor prognosis. In this short review, we summarize the current literature that describes homotypic and heterotypic CTC clusters, both in the context of their molecular characteristics as well as their value in the clinical setting. While CTC clusters have only recently emerged as key players in the metastatic process and many aspects of their biology remain to be investigated, a detailed understanding of their vulnerabilities may pave the way towards the generation of new metastasis-suppressing agents.
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Affiliation(s)
- Nicola Aceto
- Department of Biomedicine, Cancer Metastasis Laboratory, University of Basel and University Hospital Basel, Basel, Switzerland.
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37
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Sargsyan LA, Faiz SA. Pulmonary Hypertension in an Oncologic Intensive Care Unit. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123640 DOI: 10.1007/978-3-319-74588-6_47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Pulmonary hypertension (PH) is the condition of elevated pressures in the pulmonary circulation. PH can develop acutely in patients with critical illness such as acute respiratory distress syndrome, sepsis, massive pulmonary embolism, left ventricular dysfunction, or after surgery. In a cancer patient, unique etiologies such as myeloproliferative disorders, tyrosine kinase inhibitors, or tumor emboli may result in PH. Early recognition and treatment of the causative condition may reverse acute PH or return chronic PH to its baseline status. Progression of the disease or its decompensation due to infection, a thromboembolic event, or other triggers can lead to admission to an intensive care unit. Regardless of etiology, the development or worsening of PH may precipitate hypoxemia, hemodynamic instability, or right ventricular failure, which can be challenging to manage or even fatal. In select cases, rapid institution of advanced treatment modalities may be warranted. This chapter reviews the etiology, epidemiology, pathophysiology, clinical features, diagnosis, and prognosis of PH and presents a comprehensive analysis of PH and right heart failure management strategies in the critical care setting. In particular, a unique perspective on oncologically relevant PH is provided.
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38
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Narechania S, Renapurkar R, Heresi GA. Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review. Pulm Circ 2020; 10:2045894019882620. [PMID: 32257112 PMCID: PMC7103595 DOI: 10.1177/2045894019882620] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/21/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by mechanical obstruction of large pulmonary arteries secondary to one or more episodes of pulmonary embolism. Ventilation perfusion scan is the recommended initial screening test for this condition and typically shows multiple large mismatched perfusion defects. However, not all patients with an abnormal ventilation perfusion scan have CTEPH since there are other conditions that be associated with a positive ventilation perfusion scan. These conditions include in situ thrombosis, pulmonary artery sarcoma, fibrosing mediastinitis, pulmonary vasculitis and sarcoidosis, among others. Although these conditions cannot be distinguished from CTEPH using a ventilation perfusion scan, they have certain characteristic radiological features that can be demonstrated on other imaging techniques such as computed tomography scan and can help in differentiation of these conditions. In this review, we have summarized some key clinical and radiological features that can help differentiate CTEPH from the CTEPH mimics.
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Affiliation(s)
| | - Rahul Renapurkar
- Department of Diagnostic Radiology,
Cleveland
Clinic, Cleveland, OH, USA
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39
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Mastan A, Tay WF, Helliwell L, Nazir T. Fatal pulmonary tumour micro-emboli in a young woman with no history of cancer. Br J Hosp Med (Lond) 2019; 80:676-677. [PMID: 31707884 DOI: 10.12968/hmed.2019.80.11.676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Arshiya Mastan
- Specialist Trainee in Respiratory Medicine, Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - Wei F Tay
- Core Medical Trainee, Department of Medicine, Royal Preston Hospital, Preston
| | - Lee Helliwell
- Consultant Physician in Emergency and Acute Medicine, Department of Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - Tahir Nazir
- Postgraduate Doctoral Researcher in Cardiovascular Sciences, Institute of Cardiovascular Sciences, University of Manchester, Manchester M13 9PL
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40
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Kirsch D, Scordi-Bello I. Fatal Microscopic Pulmonary Tumor Thromboemboli: Unusual Presentation of Occult Cervical Carcinoma. Two Case Reports and Review of the Literature. Acad Forensic Pathol 2019; 9:81-92. [PMID: 34394793 DOI: 10.1177/1925362119851131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/15/2022]
Abstract
Cor pulmonale (right heart failure) due to microscopic pulmonary tumor emboli (MPTE) can arise from a variety of malignancies including breast, lung, and liver and carries significant morbidity and mortality. Tumor cell aggregates spread hematogenously to the lungs and occlude small pulmonary vessels leading to pulmonary hypertension through either a mechanical process or inducing vascular remodeling as a downstream result of interactions between the embolus and the vessel wall. Its presentation includes unexplained dyspnea, hypoxemia, tachycardia, pulmonary hypertension, right heart failure, and in some cases sudden death. The symptoms may suggest the more common entity of pulmonary thromboembolism, particularly in the setting of previously known metastatic cancer; however, computed tomography scans may appear normal and ventilation-perfusion scans which are the preferable diagnostic modality are not always ordered. In most cases of MPTE, the presentation reflects metastasis of an already known and advanced tumor, but, in rare cases, it may be the primary manifestation of an occult malignancy. We present here 2 unique cases of MPTE in women with occult cervical cancer. In both cases, the malignancy was discovered and diagnosed at autopsy. Microscopic pulmonary tumor emboli can be easily overlooked, and therefore, forensic pathologists and other death investigators should be aware of it and trained to at least consider the possibility in appropriate situations. Thorough microscopic examination of apparently normal tissues may be necessary, particularly in cases of unexplained right heart failure and sudden death, even if the decedent has few or no identifiable risk factors for cancer.
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41
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Tran LK, Gross LM, Hagley P, Minkin R. Pulmonary hypertension in metastatic breast cancer: a case of pulmonary tumour thrombotic microangiopathy. BMJ Case Rep 2019; 12:12/9/e229715. [DOI: 10.1136/bcr-2019-229715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary tumour thrombotic microangiopathy (PTTM) and pulmonary tumour emboli (PTE) are distinct but related complications of malignancy. The incidence of each is exceedingly rare, unfortunately often being diagnosed postmortem. Patients with PTTM and PTE typically present with dyspnoea associated with a rapid onset of hypoxia due to pulmonary hypertension (PH), and respiratory failure that is almost certain to be fatal. The prognosis is grim due to the rapidity of the clinical decline and difficulty in establishing an ante-mortem diagnosis. We present a case of new-onset severe PH in a young woman with a recently discovered breast mass. She presented with shortness of breath and experienced rapid deterioration of her cardiopulmonary status which we attributed to PTTM. With early initiation of chemotherapy, systemic steroids and sildenafil, the patient dramatically improved. Case reports have identified early use of steroids, phosphodiesterase inhibitors and other alternative therapies as providing possible benefit in PTTM.
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42
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Acute Hypoxemic Respiratory Failure Presenting with Centrilobular Nodules on Computed Tomographic Pulmonary Angiography. Ann Am Thorac Soc 2019; 14:1344-1347. [PMID: 28763265 DOI: 10.1513/annalsats.201604-311cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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43
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Sun Z, Velázquez-Quesada I, Murdamoothoo D, Ahowesso C, Yilmaz A, Spenlé C, Averous G, Erne W, Oberndorfer F, Oszwald A, Kain R, Bourdon C, Mangin P, Deligne C, Midwood K, Abou-Faycal C, Lefebvre O, Klein A, van der Heyden M, Chenard MP, Christofori G, Mathelin C, Loustau T, Hussenet T, Orend G. Tenascin-C increases lung metastasis by impacting blood vessel invasions. Matrix Biol 2019; 83:26-47. [PMID: 31288084 DOI: 10.1016/j.matbio.2019.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/30/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
Metastasis is a major cause of death in cancer patients. The extracellular matrix molecule tenascin-C is a known promoter of metastasis, however the underlying mechanisms are not well understood. To further analyze the impact of tenascin-C on cancer progression we generated MMTV-NeuNT mice that develop spontaneous mammary tumors, on a tenascin-C knockout background. We also developed a syngeneic orthotopic model in which tumor cells derived from a MMTV-NeuNT tumor. Tumor cells were transfected with control shRNA or with shRNA to knockdown tenascin-C expression and, were grafted into the mammary gland of immune competent, wildtype or tenascin-C knockout mice. We show that stromal-derived tenascin-C increases metastasis by reducing apoptosis and inducing the cellular plasticity of cancer cells located in pulmonary blood vessels invasions (BVI), before extravasation. We characterized BVI as organized structures of tightly packed aggregates of proliferating tumor cells with epithelial characteristics, surrounded by Fsp1+ cells, internally located platelets and, a luminal monolayer of endothelial cells. We found extracellular matrix, in particular, tenascin-C, between the stromal cells and the tumor cell cluster. In mice lacking stromal-derived tenascin-C, the organization of pulmonary BVI was significantly affected, revealing novel functions of host-derived tenascin-C in supporting the integrity of the endothelial cell coat, increasing platelet abundance, tumor cell survival, epithelial plasticity, thereby promoting overall lung metastasis. Many effects of tenascin-C observed in BVI including enhancement of cellular plasticity, survival and migration, could be explained by activation of TGF-β signaling. Finally, in several human cancers, we also observed BVI to be surrounded by an endothelial monolayer and to express tenascin-C. Expression of tenascin-C is specific to BVI and is not observed in lymphatic vascular invasions frequent in breast cancer, which lack an endothelial lining. Given that BVI have prognostic significance for many tumor types, such as shorter cancer patient survival, increased metastasis, vessel occlusion, and organ failure, our data revealing a novel mechanism by which stromal tenascin-C promotes metastasis in human cancer, may have potential for diagnosis and therapy.
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Affiliation(s)
- Zhen Sun
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Inés Velázquez-Quesada
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Devadarssen Murdamoothoo
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Constance Ahowesso
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Alev Yilmaz
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Caroline Spenlé
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Gerlinde Averous
- Department of Pathology, University Hospital Strasbourg, Strasbourg, France
| | - William Erne
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | | | - Andre Oszwald
- Department of Pathology, Medical University of Vienna (MUW), Vienna, Austria
| | - Renate Kain
- Department of Pathology, Medical University of Vienna (MUW), Vienna, Austria
| | | | - Pierre Mangin
- Etablissement Français du Sang, INSERM U949, Strasbourg, France
| | - Claire Deligne
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Kim Midwood
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Chérine Abou-Faycal
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Olivier Lefebvre
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Annick Klein
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Michael van der Heyden
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | | | | | - Carole Mathelin
- Department of breast diseases and surgery, Strasbourg University Hospital, Strasbourg, France
| | - Thomas Loustau
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Thomas Hussenet
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Gertraud Orend
- INSERM U1109 - MN3T, The Microenvironmental Niche in Tumorigenesis and Targeted Therapy and, the Tumor Microenvironment group, France; Université de Strasbourg, Strasbourg, France; LabEx Medalis, Université de Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.
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Jreige M, Dunet V, Letovanec I, Prior JO, Meuli RA, Beigelman-Aubry C, Schaefer N. Pulmonary Lymphangitic Carcinomatosis: Diagnostic Performance of High-Resolution CT and 18F-FDG PET/CT in Correlation with Clinical Pathologic Outcome. J Nucl Med 2019; 61:26-32. [PMID: 31227574 DOI: 10.2967/jnumed.119.229575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
The rationale of this study was to investigate the performance of high-resolution CT (HRCT) versus 18F-FDG PET/CT for the diagnosis of pulmonary lymphangitic carcinomatosis (PLC). Methods: In this retrospective institution-approved study, 94 patients addressed for initial staging of lung cancer with suspicion of PLC were included. Using double-blind analysis, we assessed the presence of signs favoring PLC on HRCT (smooth or nodular septal lines, subpleural nodularity, peribronchovascular thickening, satellite nodules, lymph node enlargement, and pleural effusion). 18F-FDG PET/CT images were reviewed to qualitatively evaluate peritumoral uptake and to quantify tracer uptake in the tumoral and peritumoral areas. Histology performed on surgical specimens served as the gold standard for all patients. Results: Among 94 included patients, 73% (69/94) had histologically confirmed PLC. Peribronchovascular thickening, lymph node involvement, and increased peritumoral uptake were more often present in patients with PLC (P < 0.009). Metabolic variables, including tumor SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis, as well as peritumoral SUVmax, SUVmean, and their respective ratios to background, were significantly higher in the PLC group than in the non-PLC group (P ≤ 0.0039). Sensitivity, specificity, and area under the receiver-operating-characteristic curve for peribronchovascular thickening (69%, 83%, and 0.76, respectively; 95% confidence interval [95%CI], 0.67-0.85) and increased peritumoral uptake (94%, 84%, and 0.89, respectively; 95%CI, 0.81-0.97) were similar (P = 0.054). For detecting PLC, sensitivity, specificity, and area under the receiver-operating-characteristic curve were significantly higher, at 97%, 92%, and 0.98, respectively (95%CI, 0.96-1.00), for peritumoral SUVmax and 94%, 88%, and 0.96, respectively (95%CI, 0.92-1.00), for peritumoral SUVmean (all P ≤ 0.025). Conclusion: Qualitative evaluation of 18F-FDG PET/CT and HRCT perform similarly for the diagnosis of PLC, with both being outperformed by 18F-FDG PET/CT quantitative parameters.
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Affiliation(s)
- Mario Jreige
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Igor Letovanec
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Reto A Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland; and
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease with significant morbidity. It is a result of an alternate natural history in which there is limited resolution of thromboemboli with pulmonary artery obstruction leading to pulmonary hypertension (PH). CTEPH requires a thorough clinical assessment including pulmonary hemodynamics and radiologic evaluation in addition to consultation with an expert center. Surgical intervention remains the optimal management strategy. Select patients may be candidates for catheter-based intervention with balloon pulmonary angioplasty in centers with clinical expertise. Inoperable patients or those with post-intervention PH are treated with pulmonary hypertension-targeted medical therapy.
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Affiliation(s)
- Jean M Elwing
- Pulmonary Hypertension Program, Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0564, Cincinnati, OH 45267, USA.
| | - Anjali Vaidya
- Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program, Advanced Heart Failure and Cardiac Transplant, Temple University School of Medicine, Temple University Hospital, 9th Floor Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - William R Auger
- CTEPH Program, UC San Diego Health, University of California, San Diego, 9300 Campus Point Drive #7381, La Jolla, CA 92037, USA
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46
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Rudkovskaia AA, Bandyopadhyay D. Intraluminal Arterial Filling Defects Misdiagnosed as Pulmonary Emboli: What Else Could They Be? Clin Chest Med 2019; 39:505-513. [PMID: 30122175 DOI: 10.1016/j.ccm.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Correct diagnosis is based on the appropriate clinical suspicion considering the unique clinical features, laboratory findings, and additional radiologic clues inferring a pathology other than pulmonary embolism.
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Affiliation(s)
- Anastasiia A Rudkovskaia
- Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA.
| | - Debabrata Bandyopadhyay
- Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA
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47
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Sato N, Tasaki T, Noguchi H, Irie K, Nakayama T. The pathological challenge of establishing a precise diagnosis for pulmonary tumour thrombotic microangiopathy: identification of new diagnostic criteria. Histopathology 2019; 74:892-901. [DOI: 10.1111/his.13813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Naoko Sato
- Department of Pathology School of Medicine University of Occupational and Environmental HealthKitakyushu Japan
| | - Takashi Tasaki
- Department of Pathology School of Medicine University of Occupational and Environmental HealthKitakyushu Japan
| | - Hirotsugu Noguchi
- Department of Pathology School of Medicine University of Occupational and Environmental HealthKitakyushu Japan
| | - Koji Irie
- Department of Diagnostic Pathology Kitakyushu General Hospital Kitakyushu Japan
| | - Toshiyuki Nakayama
- Department of Pathology School of Medicine University of Occupational and Environmental HealthKitakyushu Japan
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48
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Habib S, Azam M, Siddiqui AH, Rajdev K, Chalhoub M. Hepatocellular Carcinoma After Successful Treatment of Hepatitis C Virus with Ledipasvir/Sofosbuvir Presenting as Acute Pulmonary Tumor Embolism. Cureus 2019; 11:e4336. [PMID: 31187001 PMCID: PMC6541161 DOI: 10.7759/cureus.4336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hepatitis C virus (HCV)-induced cirrhosis is a major cause of hepatocellular carcinoma (HCC) worldwide. HCC is an aggressive malignancy in which tumor thrombus can invade portal vein, hepatic veins and inferior vena cava (IVC) in the later stages. Our case brings to attention, HCV patient population who might need long-term follow-up to ensure HCV clearance. Physicians should ensure appropriate follow-up after treatment of HCV and should emphasize on the ongoing screening for HCC in patients with cirrhosis or advanced fibrosis, regardless of antiviral treatment outcome.
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Affiliation(s)
- Saad Habib
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Mohammed Azam
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Abdul Hasan Siddiqui
- Pulmonary and Critical Care Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Kartikeya Rajdev
- Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
| | - Michel Chalhoub
- Pulmonary and Critical Care Medicine, Staten Island University Hospital, Northwell Health, Staten Island, USA
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49
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Li X, Xu Y, Liu Y, Cheng X, Wang X, Lu W, Xie X. The management of hydatidiform mole with lung nodule: a retrospective analysis in 53 patients. J Gynecol Oncol 2019; 30:e16. [PMID: 30740949 PMCID: PMC6393642 DOI: 10.3802/jgo.2019.30.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the significance of lung nodule in hydatidiform mole, we retrospectively compared the clinical outcomes of those patients treated with different strategies. Methods The patients were divided into three groups: chemotherapy immediately once lung nodule was detected (group 1, n=17), delayed chemotherapy until human chorionic gonadotrophin (hCG) level met the diagnostic criteria for gestational trophoblastic neoplasia (GTN) (group 2, n=18), and hCG surveillance alone until hCG level was normalized spontaneously (group 3, n=18). The clinical parameters of these patients were collected and analyzed. Results Totally 53 (4.0%) patients were included from 1,323 cases with molar pregnancy during past 16 years. Among them, the diameters of lung nodules were 0.3–2.5 cm. Chemotherapy cycles for achieving hCG normalization and the failure rate of first-line chemotherapy in group 1 were significantly increased than that in group 2 (5 vs. 3 cycles, p=0.000, 58.8% vs. 11.1%, p=0.005). The hCG level of all 18 cases in group 3 was normalized spontaneously within 6 months. Of those, lung nodules of 9 patients disappeared spontaneously, accounting for 25% (9/36) of patients who initially selected observation. The proportion of single nodule in group 3 was significantly higher than that in group 2 (10/18 vs. 2/18, p=0.012). Conclusion Our results suggest that lung nodule alone is not an adequate indication of chemotherapy in molar pregnancy. hCG surveillance is safe for patients with lung nodule, especially with single nodule, as long as their hCG levels do not meet International Federation of Gynecology and Obstetrics diagnostic criteria for GTN.
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Affiliation(s)
- Xiao Li
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yaping Xu
- Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Obstetrics and Gynecology, Hangzhou Red Cross Hospital, Hangzhou, China
| | - Yuanyuan Liu
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaodong Cheng
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyu Wang
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiguo Lu
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Hangzhou, China
| | - Xing Xie
- Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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50
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Price LC, Seckl MJ, Dorfmüller P, Wort SJ. Tumoral pulmonary hypertension. Eur Respir Rev 2019; 28:28/151/180065. [DOI: 10.1183/16000617.0065-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/23/2018] [Indexed: 12/15/2022] Open
Abstract
Tumoral pulmonary hypertension (PH) comprises a variety of subtypes in patients with a current or previous malignancy. Tumoral PH principally includes the tumour-related pulmonary microvascular conditions pulmonary tumour microembolism and pulmonary tumour thrombotic microangiopathy. These inter-related conditions are frequently found inpost mortemspecimens but are notoriously difficult to diagnoseante mortem. The outlook for patients remains extremely poor although there is some emerging evidence that pulmonary vasodilators and anti-inflammatory approaches may improve survival. Tumoral PH also includes pulmonary macroembolism and tumours that involve the proximal pulmonary vasculature, such as angiosarcoma; both may mimic pulmonary embolism and chronic thromboembolic PH. Finally, tumoral PH may develop in response to treatments of an underlying malignancy. There is increasing interest in pulmonary arterial hypertension induced by tyrosine kinase inhibitors, such as dasatanib. In addition, radiotherapy and chemotherapeutic agents such as mitomycin-C can cause pulmonary veno-occlusive disease. Tumoral PH should be considered in any patient presenting with unexplained PH, especially if it is poorly responsive to standard approaches or there is a history of malignancy. This article will describe subtypes of tumoral PH, their pathophysiology, investigation and management options in turn.
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