2025 年 3 巻 1 号 p. 18-21
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and frequently fatal complication associated with advanced gastric cancer, characterized by progressive dyspnea, pulmonary hypertension, and right heart failure. Diagnosing PTTM is challenging owing to its rapid progression and ability to mimic other respiratory conditions. Transbronchial lung cryobiopsy (TBLC) has recently emerged as a valuable diagnostic tool, providing larger and more intact tissue samples than conventional transbronchial lung biopsy (TBLB), which is often limited by tissue crush artifacts.
We present a case of a 58-year-old male with rapidly worsening dyspnea, hypoxemia, and right heart strain. Chest computed tomography revealed interlobular septal thickening and ground-glass opacity. TBLC from the right lower lobe confirmed a diagnosis of PTTM, with tumor cells detected in the pulmonary vessels and fibrous intimal thickening. Upper gastrointestinal endoscopy revealed Borrmann type 4 gastric cancer. Despite planning chemotherapy, the patient succumbed to cardiopulmonary arrest.
This case highlights the importance of TBLC as a diagnostic method for PTTM, as it can facilitate earlier detection and treatment. Further study is required to evaluate the safety of TBLC and explore potential therapeutic strategies for improving patient outcomes in PTTM.
