Tumor-related thrombotic pulmonary microangiopathy

Review of pathologic findings and pathophysiologic mechanisms

J. Keith Pinckard, Mark R. Wick

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)154-157
Number of pages4
JournalAnnals of Diagnostic Pathology
Volume4
Issue number3
StatePublished - Jun 2000

Fingerprint

Thrombotic Microangiopathies
Lung
Pulmonary Hypertension
Neoplasms
Pulmonary Embolism
Autopsy
Krukenberg Tumor
Tunica Intima
Embolism
Respiratory Insufficiency
Dyspnea
Pulmonary Artery
Smooth Muscle
Ovary
Stomach
Neoplasm Metastasis
Carcinoma

Keywords

  • Gastric carcinoma
  • Krukenberg tumor
  • Tumor-related thrombotic pulmonary microangiopathy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Tumor-related thrombotic pulmonary microangiopathy : Review of pathologic findings and pathophysiologic mechanisms. / Pinckard, J. Keith; Wick, Mark R.

In: Annals of Diagnostic Pathology, Vol. 4, No. 3, 06.2000, p. 154-157.

Research output: Contribution to journalArticle

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