Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases

BMC Gastroenterology

Mai Sakashita¹  Yoko Wakai²  Naoki Kawakami²  Kentaro Nakamura²  Kazuhito Saito²  Tomohiro Moriya²  Rina Kato²  Hiroaki Saito² 

[1] Department of Pathology, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, 300-0028, Tsuchiura, Ibaraki, Japan;Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, 300-0028, Tsuchiura, Ibaraki, Japan;

关键词: Pulmonary tumor thrombotic microangiopathy;    Early gastric cancer;    Signet ring cell carcinoma;    Endoscopy;    Imatinib;   

DOI  :  10.1186/s12876-021-02009-8

来源: Springer

【 摘 要 】

BackgroundPulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported.Case presentationA previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer.ConclusionsDespite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable.

【 授权许可】

CC BY