Abe Tomomi, Fukada Ippei, Shiga Taro, Morizono Hidetomo, Ikebata Koichi, Shibayama Tomoko, Kobayashi Kokoro, Iwase Takuji, Ohno Shinji, Ito Yoshinori
Department of Breast Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Breast Medical Oncology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Case Rep Oncol. 2017 Jul 11;10(2):620-626. doi: 10.1159/000477842. eCollection 2017 May-Aug.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare, cancer-related, pulmonary complication that causes hypoxia and pulmonary hypertension. We report on a 42-year-old woman who was diagnosed with recurrent breast cancer that was detected due to the presence of PTTM. Eleven months after surgery for heterochronous bilateral cancer of the left breast, she developed progressive dyspnea but computerized tomography showed no pulmonary thromboembolism, and a transthoracic echocardiography revealed mild pulmonary hypertension. She was diagnosed with PTTM by cytology from pulmonary artery catheterization and perfusion lung scintigraphy. Also, the patients complained of back pain after admission, bone scintigraphy showed multiple bone metastases. Despite the early diagnosis of PTTM, her platelet count decreased, her performance status rapidly deteriorated, and her dyspnea worsened. Thus, we could not treat her with chemotherapy. She died due to respiratory failure 19 days after admission. To the best of our knowledge, this is the first report of recurrent breast cancer identified by the manifestation of PTTM. Although PTTM is a rare phenomenon, it should be considered in the differential diagnosis of acute dyspnea or pulmonary hypertension in patients with breast cancer. Furthermore, upon diagnosis, the patient should be referred to a cardiologist as soon as possible.
肺肿瘤血栓性微血管病（PTTM）是一种罕见的、与癌症相关的肺部并发症，可导致缺氧和肺动脉高压。我们报告了一名42岁女性，她被诊断为复发性乳腺癌，该病因PTTM的存在而被发现。在因左侧乳房异时性双侧癌症接受手术后11个月，她出现进行性呼吸困难，但计算机断层扫描显示无肺血栓栓塞，经胸超声心动图显示轻度肺动脉高压。通过肺动脉导管检查和灌注肺闪烁扫描的细胞学检查，她被诊断为PTTM。此外，患者入院后抱怨背痛，骨闪烁扫描显示多处骨转移。尽管PTTM诊断较早，但她的血小板计数下降，其身体状况迅速恶化，呼吸困难加重。因此，我们无法对她进行化疗。她在入院19天后因呼吸衰竭死亡。据我们所知，这是首例通过PTTM表现确诊的复发性乳腺癌报告。尽管PTTM是一种罕见现象，但在乳腺癌患者急性呼吸困难或肺动脉高压的鉴别诊断中应予以考虑。此外，一旦确诊，应尽快将患者转诊给心脏病专家。
