Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn.
Department of Pathology and Laboratory Medicine, University of Chicago, NorthShore University HealthSystem, Evanston, Ill.
J Vasc Surg. 2018 Jul;68(1):204-212.e7. doi: 10.1016/j.jvs.2017.09.045. Epub 2018 Mar 1.
Arterial neoplastic emboli are uncommon, accounting for <1% of thromboemboli in the current literature. Nonetheless, this event may be associated with significant morbidity and mortality. Herein, we report a series of 11 cases of arterial neoplastic emboli from a single tertiary care center along with a comprehensive review of the literature to date. The aim of this study was to document the incidence, clinical presentations, and complications of arterial neoplastic emboli as well as to highlight the importance of routine histologic examination of thrombectomy specimens.
Pathology archives from a single tertiary care institution were queried to identify cases of surgically resected arterial emboli containing neoplasm (1998-2014). Histopathology was reviewed for confirmation of diagnosis. Patient demographics and oncologic history were abstracted from the medical record. Comprehensive literature review documented 332 patients in 275 reports (1930-2016).
Eleven patients (six men) with a median age of 63 years (interquartile range, 42-71 years) were identified through institutional archives. Embolism was the primary form of diagnosis in seven (64%) cases. Cardiac involvement (primary or metastasis) was present in more than half of the cohort. Comprehensive literature review revealed that pulmonary primaries were the most common anatomic origin of arterial neoplastic emboli, followed by gastrointestinal neoplasia. Cardiac involvement was present in 18% of patients, and sentinel identification of neoplasia occurred in 30% of cases. Postmortem evaluation was the primary means of diagnosis in 27%.
This study highlights the importance of routine histopathologic evaluation of embolectomy specimens in patients with and without documented neoplasia.
动脉肿瘤性栓子并不常见，在目前的文献中占血栓栓子的<1%。尽管如此，这种情况可能与显著的发病率和死亡率相关。在此，我们报告了来自单一三级护理中心的 11 例动脉肿瘤性栓子病例，并对迄今为止的文献进行了全面回顾。本研究的目的是记录动脉肿瘤性栓子的发生率、临床表现和并发症，并强调常规检查血栓切除术标本的组织学检查的重要性。
对单一三级护理机构的病理档案进行查询，以确定包含肿瘤的手术切除动脉栓子（1998-2014 年）的病例。对组织病理学进行了复查以确认诊断。从病历中提取患者人口统计学和肿瘤学病史。全面的文献综述记录了 275 份报告中的 332 例患者（1930-2016 年）。
通过机构档案确定了 11 例患者（6 例男性），中位年龄为 63 岁（四分位间距，42-71 岁）。栓塞是 7 例（64%）患者的主要诊断形式。一半以上的患者存在心脏受累（原发性或转移性）。全面的文献综述显示，肺部原发性肿瘤是动脉肿瘤性栓子最常见的解剖起源，其次是胃肠道肿瘤。18%的患者存在心脏受累，30%的患者发生肿瘤的早期识别。尸检是 27%的主要诊断方法。
本研究强调了对有或无明确肿瘤患者的血栓切除术标本进行常规组织病理学评估的重要性。
