Abstract
Background : Malignancy-associated pulmonary hypertension (PH) is a rare condition encountered in patients with cancers or hematological disorders. We present the findings of pulmonary blood aspiration cytology in two cases of PH associated with breast cancer and polycythemia vera, respectively.
Cases : Case 1 : A 59-year-old woman who had been treated for breast cancer 6 years earlier presented to us complaining of severe breathlessness. We performed right heart catheterization for PH and cytological examination of the pulmonary blood. Many cancer cells were detected in the blood smear and cell blocks, consistent with the diagnosis of pulmonary tumor-thrombotic microangiopathy. She was started on chemotherapy, but died of respiratory failure 7 months later.
Case 2 : A 72-year-old woman who had been diagnosed as having polycythemia vera and had been under treatment with an antimetabolite for 21 years presented to us with a history of exertional breathlessness. We performed pulmonary catheterization to confirm PH, and concomitant cytological examination. The blood smear showed megakaryocytes with platelet production and giant platelets. The patient was started on chemotherapy for myeloproliferative disorder, however, she died of respiratory failure after a year.
Conclusion : Patients with PH associated with malignancy cannot easily be treated by invasive approaches, and have a poor prognosis due to their often missing the chance for early treatment, as diagnosis, and consequently treatment, is often delayed. Therefore, heart catheterization with concomitant pulmonary blood aspiration cytology is safe and diagnostically useful for those patients.
