A Case of Gastric Cancer Suspected Pulmonary Tumor Thrombotic Microangiopathy

Rie Nishikata, Masanori Terashima, Nobutoshi Soeta, Satoshi Ohtani, Shinichi Matsuyama, Yutaka Hoshino, Michihiko Kogure and Mitsukazu Gotoh

Department of Surgery 1, Fukushima Medical University

A 52-year-old man transferred to our hospital for suspected gastric cancer with epigastralgia, weight loss, and appetite loss was found in gastrointestinal fiber to have type 4 gastric cancer. Gastric biopsy showed signet ring cell carcinoma. When scheduled for neoajuvant chemotherapy, he reported exertional dyspnea and presented with hypoxemia and hypocapnia. Chest CT showed diffuse granular shadows and thickened broncovessel bundles. Lung perfusion study showed stringy defects indicating the presence of multiple microembolisms. On hospital day 8, dyspnea suddenly worsened, and chest CT showed increased macular shadows. He died of respiratory failure on hospital day 10. Necropsy of the lung showed fibrocellular intimal proliferation, organized thrombi, and recanalization in small pulmonary arteries compatible with pulmonary tumor thrombotic microangiopathy (PTTM).

Key words
pulmonary tumor thrombotic microangiopathy, pulmonary hypertension, gastric cancer

Reprint requests
Masanori Terashima Department of Surgery 1, Fukushima Medical University
1 Hikarigaoka, Fukushima, 960-1295 JAPAN

Accepted
February 23, 2005

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