Pulmonary Tumor Thrombotic Microangiopathy Diagnosed Antemortem and Treated with Combination Chemotherapy

• Published in: Internal Medicine Vol. 51; no. 19; pp. 2767 - 2770
• Main Authors: Kayatani, Hiroe, Matsuo, Kiyoshi, Ueda, Yusuke, Matsushita, Mizuho, Fujiwara, Keiichi, Yonei, Toshiro, Yamadori, Ichiro, Shigematsu, Hisayuki, Andou, Akio, Sato, Toshio
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-01-2012
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols; Biopsy; cancer of unknown primary; Carcinoma, Signet Ring Cell - complications; Carcinoma, Signet Ring Cell - diagnosis; Carcinoma, Signet Ring Cell - drug therapy; Cisplatin - administration & dosage; combination chemotherapy; Drug Combinations; Fatal Outcome; Humans; Hypertension, Pulmonary - etiology; Lung Neoplasms - blood supply; Lung Neoplasms - complications; Lung Neoplasms - diagnosis; Lung Neoplasms - drug therapy; Male; Neoplasms, Unknown Primary - complications; Neoplasms, Unknown Primary - diagnosis; Neoplasms, Unknown Primary - drug therapy; Oxonic Acid - administration & dosage; Pulmonary Artery - pathology; pulmonary hypertension; pulmonary tumor thrombotic microangiopathy; Tegafur - administration & dosage; Thoracic Surgery, Video-Assisted; Thrombotic Microangiopathies - diagnosis; Thrombotic Microangiopathies - drug therapy; Thrombotic Microangiopathies - etiology; Tomography, X-Ray Computed
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.51.7682

A 29-year-old man developed a persistent dry cough. Chest high-resolution computed tomography (HRCT) revealed centrilobular ultrafine granular shadows scattered in all lung fields. A lung biopsy with video-assisted thoracoscopic surgery revealed findings compatible with pulmonary tumor thrombotic microangiopathy (PTTM). However, the primary tumor was not identified. Combination chemotherapy with S-1 and cisplatin decreased his cough and improved the chest HRCT findings. The illness, however, gradually became difficult to control. He eventually developed pulmonary hypertension and died. Typically, an antemortem diagnosis of PTTM cannot be made. In this case, the diagnosis of PTTM and combination chemotherapy improved the chest HRCT findings, respiratory symptoms, and prognosis.