Hara Atsuko, Ichinoe Masaaki, Ogawa Taishi, Shiraishi Hiroaki, Okayasu Isao
Department of Pathology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
Pathol Res Pract. 2005;201(6):457-61. doi: 10.1016/j.prp.2005.05.002.
Pulmonary tumor thrombotic microangiopathy (PTTM), characterized by widespread fibrocellular intimal proliferation of the small pulmonary arteries and arterioles in patients with metastatic carcinomas, has been reported in only few cases. In childhood, gastrointestinal tumors represent less than 5% of pediatric neoplasms, and carcinomas within this subgroup have been very rarely described, in particular those arising in the stomach. We report on a case of a microscopic gastric signet-ring cell carcinoma identified by serial step sections through the entire stomach at autopsy. The patient was a 17-year-old high school student with severe dyspnea and marked pulmonary hypertension due to PTTM. Although the combination of PTTM with gastric cancer is very rare in childhood, it should be considered in the differential diagnosis of primary pulmonary hypertension and progressive respiratory failure, as indicated by a review of previously reported cases.
肺肿瘤血栓性微血管病（PTTM）的特征是转移性癌患者的小肺动脉和小动脉广泛出现纤维细胞内膜增生，仅有少数病例报告。在儿童时期，胃肠道肿瘤占小儿肿瘤的比例不到5%，该亚组内的癌非常罕见，尤其是发生在胃的癌。我们报告一例通过尸检对整个胃进行连续阶梯切片而确诊的显微镜下胃印戒细胞癌病例。该患者是一名17岁的高中生，因PTTM出现严重呼吸困难和明显的肺动脉高压。尽管儿童期PTTM合并胃癌的情况非常罕见，但正如对既往报道病例的回顾所示，在原发性肺动脉高压和进行性呼吸衰竭的鉴别诊断中应考虑到这种情况。
