Cor pulmonale due to tumor cell microemboli. Report of a case with occult gastric carcinoma.

Progressive dyspnea developed in a 36-year-old woman. Physical examination and chest roentgenogram showed the signs of pulmonary hypertension. She died of respiratory failure in spite of treatment. Autopsy disclosed gastric carcinoma in the pylorus with metastases to the regional lymph nodes, left adrenal gland, and ovaries. There were no gross pulmonary emboli, but more than 50% of pulmonary microvasculature was occluded by tumor cell microemboli. No parenchymal metastases were found in the lung. This case was remarkable because cor pulmonale due to tumor cell microemboli to the lung was the initial and terminal manifestation of clinically occult, but pathologically advanced, gastric carcinoma.