A Case of Breast Cancer with Histologically Diagnosed Pulmonary Tumor Thrombotic Microangiopathy during Survival

Abstract

A 71-year-old woman underwent partial mastectomy for left breast cancer (T1bN0M0). She refused adjuvant therapy and had been followed up without treatments. Three years and five months after the surgery, metastasis to the left axillary lymph node and multiple bone metastases were observed, and further three months later dyspnea appeared. A chest computed tomography showed multiple infiltrative and frosted shadows in both lungs, a transbronchial lung biopsy showed tumor embolization in the blood vessels, and an echocardiography showed right heart failure. We suspected pulmonary tumor thrombotic microangiopathy (PTTM) and continued anticoagulant therapy, but the condition took a progressive downhill course and the patient died on the 20th hospital day. Clinicians should consider PTTM as a differential diagnosis in patients with cancer who develop progressive dyspnea and right heart failure.