TY - JOUR
T1 - Tumor-related thrombotic pulmonary microangiopathy
T2 - Review of pathologic findings and pathophysiologic mechanisms
AU - Pinckard, J. Keith
AU - Wick, Mark R.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2000/6
Y1 - 2000/6
N2 - We report a middle-aged woman who died 2 days after presenting with dyspnea and severe pulmonary hypertension of unknown etiology. Her symptoms were highly suggestive of pulmonary embolism, but clinical evaluations for that disease yielded negative results. Autopsy revealed a Krukenberg tumor of the left ovary, representing metastatic gastric carcinoma from an occult primary lesion. Although the lungs exhibited no gross evidence of pulmonary emboli or neoplasia, microscopic examination revealed diffuse microscopic metastases in the pulmonary arterial vasculature. The pulmonary arteries exhibited fibrocellular intimal proliferation with smooth muscle colonization of the luminal neoplastic lesions and associated microthrombi. This disease entity, known as tumor-related thrombotic pulmonary microangiopathy, results in generalized microvascular obliteration and subsequent pulmonary hypertension. It is a rare condition that is distinct from ordinary pulmonary thromboembolism and primary pulmonary hypertension. Tumor-related thrombotic pulmonary microangiopathy should be considered diagnostically by the autopsy pathologist in cases of rapidly evolving pulmonary hypertension in a middle- aged or elderly individual, or respiratory failure of unknown cause, especially if there is a history of a visceral malignancy. (C) 2000 by W.B. Saunders Company.
AB - We report a middle-aged woman who died 2 days after presenting with dyspnea and severe pulmonary hypertension of unknown etiology. Her symptoms were highly suggestive of pulmonary embolism, but clinical evaluations for that disease yielded negative results. Autopsy revealed a Krukenberg tumor of the left ovary, representing metastatic gastric carcinoma from an occult primary lesion. Although the lungs exhibited no gross evidence of pulmonary emboli or neoplasia, microscopic examination revealed diffuse microscopic metastases in the pulmonary arterial vasculature. The pulmonary arteries exhibited fibrocellular intimal proliferation with smooth muscle colonization of the luminal neoplastic lesions and associated microthrombi. This disease entity, known as tumor-related thrombotic pulmonary microangiopathy, results in generalized microvascular obliteration and subsequent pulmonary hypertension. It is a rare condition that is distinct from ordinary pulmonary thromboembolism and primary pulmonary hypertension. Tumor-related thrombotic pulmonary microangiopathy should be considered diagnostically by the autopsy pathologist in cases of rapidly evolving pulmonary hypertension in a middle- aged or elderly individual, or respiratory failure of unknown cause, especially if there is a history of a visceral malignancy. (C) 2000 by W.B. Saunders Company.
KW - Gastric carcinoma
KW - Krukenberg tumor
KW - Tumor-related thrombotic pulmonary microangiopathy
UR - http://www.scopus.com/inward/record.url?scp=0033927247&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033927247&partnerID=8YFLogxK
U2 - 10.1016/S1092-9134(00)90038-8
DO - 10.1016/S1092-9134(00)90038-8
M3 - Article
C2 - 10919385
AN - SCOPUS:0033927247
SN - 1092-9134
VL - 4
SP - 154
EP - 157
JO - Annals of Diagnostic Pathology
JF - Annals of Diagnostic Pathology
IS - 3
ER -