Yasui Hideki, Akamatsu Taisuke, Nakamura Yutarou, Inui Naoki, Suda Takafumi, Chida Kingo, Meguro Shiori, Baba Satoshi
Department of Respiratory Medicine, Hamamatsu University School of Medicine, Hamamatsu University Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Feb;49(2):122-7.
A 56-year-old man with chief complaints of dry cough and dyspnea was admitted. He had severe hypoxemia, and his chest radiographs showed enhancement of pulmonary artery opacities with multiple defects on pulmonary blood flow scintigraphy. Enhanced computed tomography (CT) revealed swelling of the mediastinum and hilar lymph nodes, but no apparent thrombi in the pulmonary arteries was seen. A biopsy specimen of a left neck lymph node showed poorly differentiated adenocarcinoma, including signet-ring cell carcinoma components, but the origin was unclear. Despite receiving chemotherapy, his respiratory condition worsened, and he died 3 days after admission. Routine autopsy failed to clarify the tumor origin, but a detailed dissection of specimens confirmed early gastric cancer. Additionally, pathology of the pulmonary arteries was compatible with pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a rare condition characterized by the presence of diffuse thrombotic microthrombi and fibrocellular intimal proliferation in the pulmonary vasculature. Accompanied with early gastric cancer, this is an extremely rare but important case of PTTM.
一名以干咳和呼吸困难为主诉的56岁男性入院。他有严重的低氧血症，胸部X线片显示肺动脉影增强，肺血流闪烁显像有多处缺损。增强计算机断层扫描（CT）显示纵隔和肺门淋巴结肿大，但未见肺动脉有明显血栓。左颈部淋巴结活检标本显示为低分化腺癌，包括印戒细胞癌成分，但起源不明。尽管接受了化疗，他的呼吸状况仍恶化，入院3天后死亡。常规尸检未能明确肿瘤起源，但对标本进行详细解剖证实为早期胃癌。此外，肺动脉病理与肺肿瘤血栓性微血管病（PTTM）相符。PTTM是一种罕见的疾病，其特征是肺血管系统中存在弥漫性血栓性微血栓和纤维细胞内膜增生。伴有早期胃癌，这是一例极其罕见但重要的PTTM病例。
