Pulmonary Tumor Thrombotic Microangiopathy Due to Gastric Cancer Diagnosed Antemortem by a Cytological Examination of Aspirated Pulmonary Artery Blood

Yasuhiro Mitsui; Mai Yagi; Sho Muraki; Tomomi Matsuura; Yoshimi Bando; Shota Fujimoto; Shinji Kitamura; Koichi Okamoto; Naoki Muguruma; Masataka Sata; Tetsuji Takayama

doi:10.2169/internalmedicine.8313-21

CASE REPORTS

Pulmonary Tumor Thrombotic Microangiopathy Due to Gastric Cancer Diagnosed Antemortem by a Cytological Examination of Aspirated Pulmonary Artery Blood

Yasuhiro Mitsui, Mai Yagi, Sho Muraki, Tomomi Matsuura, Yoshimi Bando, Shota Fujimoto, Shinji Kitamura, Koichi Okamoto, Naoki Muguruma, Masataka Sata, Tetsuji Takayama

Author information

Yasuhiro Mitsui
Department of Gastroenterology and Oncology, Tokushima University Hospital, Japan
Mai Yagi
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
Department of Gastroenterology, Tokushima Prefectural Central Hospital, Japan
Sho Muraki
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
Department of Gastroenterology, Shikoku Medical Center for Children and Adults, Japan
Tomomi Matsuura
Department of Cardiovascular Medicine, Tokushima University Hospital, Japan
Yoshimi Bando
Division of Pathology, Tokushima University Hospital, Japan
Shota Fujimoto
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
Shinji Kitamura
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
Koichi Okamoto
Department of Gastroenterology and Oncology, Tokushima University Hospital, Japan
Naoki Muguruma
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan
Masataka Sata
Department of Cardiovascular Medicine, Tokushima University Hospital, Japan
Tetsuji Takayama
Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Japan

Keywords: gastric cancer, pulmonary tumor thrombotic microangiopathy (PTTM), cardiac catheterization, vascular endothelial growth factor (VEGF)

JOURNAL OPEN ACCESS

2022 Volume 61 Issue 10 Pages 1491-1495

DOI https://doi.org/10.2169/internalmedicine.8313-21

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Abstract

A 66-year-old Japanese man receiving systemic chemotherapy for advanced gastric cancer presented with exertional dyspnea. D-dimer was elevated in the blood. Echocardiography revealed pulmonary hypertension, and a ventilation-perfusion scan indicated decreased perfusion in the bilateral lungs. Cardiac catheterization showed no evidence of pulmonary artery embolization and revealed cytologically confirmed adenocarcinoma. Thus, pulmonary tumor thrombotic microangiopathy (PTTM) was diagnosed. The patient died of respiratory failure on the 17th hospitalization day despite systemic chemotherapy. Retrospective serological testing revealed increased vascular endothelial growth factor in the pulmonary artery blood. This is a rare case with antemortem cytologically proven PTTM mediated by VEGF.

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