Pulmonary Tumor Thrombotic Microangiopathy Caused by Metastatic Ovarian Cancer: An Antemortem Diagnosis with Pulmonary Aspiration Cytopathology.

Kyoko Unno, Hayato Ohtani, Atsushi Sakamoto, Hirotake Murakami, Haruna Yagi, Hiroaki Ito, Satoshi Baba, Toshihide Iwashita, Isao Kosugi, Yuichiro Maekawa

Internal medicine (Tokyo, Japan) 2023 Dec 15

filter terms:

A 48-year-old woman with advanced ovarian cancer was diagnosed with pulmonary tumor thrombotic microangiopathy (PTTM) by antemortem pulmonary wedge aspiration cytopathology. Despite the initiation of anti-cancer treatment, she unfortunately died due to progressive respiratory failure. Histopathology of the autopsied lung revealed multiple tumor embolization with fibrin-rich clot and fibro-cellular intimal proliferation at the pulmonary arteriole. The embolized tumor showed strong immune-positivity for pro-thrombotic and fibrotic factors (tissue factor and vascular endothelial growth factor), suggesting the underlying mechanisms of PTTM development. This case suggests that a quick antemortem diagnosis and the early induction of specific treatments might ensure a better prognosis of PTTM.

Citation

Kyoko Unno, Hayato Ohtani, Atsushi Sakamoto, Hirotake Murakami, Haruna Yagi, Hiroaki Ito, Satoshi Baba, Toshihide Iwashita, Isao Kosugi, Yuichiro Maekawa. Pulmonary Tumor Thrombotic Microangiopathy Caused by Metastatic Ovarian Cancer: An Antemortem Diagnosis with Pulmonary Aspiration Cytopathology. Internal medicine (Tokyo, Japan). 2023 Dec 15;62(24):3649-3655