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Itoyama M, Ohara A, Yokoyama K, Yamamoto S, Kato K, Tada Y, Sugitani A, Sugino H, Yatabe Y, Kusumoto M, Nakamura K, Honma Y. An autopsy case of pulmonary tumor thrombotic microangiopathy that developed during chemotherapy for salivary duct carcinoma of the parotid gland. Auris Nasus Larynx 2024; 51:829-833. [PMID: 39047424 DOI: 10.1016/j.anl.2024.07.002] [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: 02/10/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rapidly progressive cancer-related disease with a dismal clinical course. The patient in this report was a 43-year-old man with metastatic salivary duct carcinoma arising from the parotid gland. Combined androgen blockade therapy was administered started as first-line treatment, but failed after 5 months, followed by docetaxel plus carboplatin therapy as second-line treatment, which failed after 3 months. Genomic profiling revealed a BRAF V600E mutation, and combined BRAF and MEK inhibitor therapy was started as third-line treatment. The cancer remained stable during the first 10 months of third-line treatment, but treatment was subsequently discontinued due to the onset of symptoms of fatigue, myalgia and arthritis. Twenty days after the onset of these symptoms and interruption of third-line treatment, the patient was urgently admitted to hospital with respiratory distress and severe thrombocytopenia. CT images at the time of admission led our radiologist to the possibility of PTTM, but the patient died the day after admission and autopsy findings indicated that PTTM was the cause of death. This report describes a very informative case of PTTM with sequential imaging and detailed autopsy findings were available and provides a literature review.
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Affiliation(s)
- Mai Itoyama
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. Head
| | - Akihiro Ohara
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. Head
| | - Kazuki Yokoyama
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. Head
| | - Shun Yamamoto
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. Head
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. Head
| | - Yuichiro Tada
- Department of and Neck Oncology and Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Ayumi Sugitani
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirokazu Sugino
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasushi Yatabe
- Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kenichi Nakamura
- Department of International Clinical Development/ Clinical Research Support Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshitaka Honma
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. Head.
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Ostrominski JW, Bhatt DL, Scirica BM. Pulling Out All the Stops: A Case of Progressive Dyspnea. Circulation 2023; 147:688-693. [PMID: 36802880 DOI: 10.1161/circulationaha.122.062753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- John W Ostrominski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Deepak L Bhatt
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Benjamin M Scirica
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Stern KM, Ries S, Beltran A, Youssef FA. A 51-Year-Old Woman With Rapidly Progressive Dyspnea. Chest 2021; 159:e251-e255. [PMID: 34022028 DOI: 10.1016/j.chest.2020.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/03/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022] Open
Abstract
CASE PRESENTATION A 51-year-old woman with a history of diabetes mellitus and anemia sought treatment at the emergency room for a 2-month history of dry cough and shortness of breath and a 1-week history of substernal chest tightness. One month before her presentation, she was seen at a separate hospital for dyspnea and was found to be anemic. She underwent chest radiography and CT scanning of the chest that was unrevealing to the cause of dyspnea. She received a blood transfusion, although no cause of the anemia was found. One week before presentation, she started experiencing dyspnea on exertion with associated chest pressure, prompting her to seek treatment at the emergency room. On presentation, she reported no fevers, night sweats, joint pain, paroxysmal nocturnal dyspnea, orthopnea, edema, palpitations, lightheadedness, or syncope. She noted a 10- to 20-pound involuntary weight loss over 5 to 6 months. Of note, she had never undergone esophagogastroduodenoscopy or colonoscopy. Medications included an oral diabetic medication. She had no significant family history. She never smoked and had no history of illicit drug or alcohol use.
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Affiliation(s)
- Ken M Stern
- Pulmonary and Critical Care Medicine, University of California - Irvine, CA; East Bay Regional Critical Care and Pulmonary Medicine, Oakland, CA
| | - Savita Ries
- Department of Pathology, MemorialCare - Long Beach Medical Center, Long Beach, CA
| | - Antonio Beltran
- Division of Pulmonary and Critical Care Medicine, Long Beach Memorial Medical Center, Long Beach, CA
| | - Fady A Youssef
- Pulmonary and Critical Care Medicine, University of California - Irvine, CA; Division of Pulmonary and Critical Care Medicine, Long Beach Memorial Medical Center, Long Beach, CA.
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Pulmonary tumor thrombotic microangiopathy: the role of a lung perfusion SPECT-CT study. Eur J Nucl Med Mol Imaging 2021; 48:3340-3342. [PMID: 33772333 DOI: 10.1007/s00259-021-05323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
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