Katayama Satoshi, Takenaka Tadasu, Nakamura Aya, Sako Sinichi, Bessho Akihiro, Ohara Nobuya
Department of Urology, St.Mary's Hospital, Himeji, Hyogo 670-0801, Japan.
Acta Med Okayama. 2018 Jun;72(3):309-313. doi: 10.18926/AMO/56078.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal, malignancy-related respiratory complication; we herein report a PTTM case induced by metastatic prostate cancer. An 81-year-old Japanese man developed dyspnea. High-resolution computed tomography (HRCT) revealed ground-glass opacities spread across bilateral lung fields. Pulmonary microvascular aspiration cytology detected prostate cancer cells. As PTTM was highly suspected, docetaxel chemotherapy was performed immediately. His respiratory condition and HRCT findings improved temporarily, but he died approx. 6 weeks after admission. Autopsy showed fibrocellular intimal proliferation of small pulmonary arterioles, which confirmed the diagnosis of PTTM induced by prostate cancer. As in the present case, it is often difficult to confirm the presence of not only tumor embolization but also fibrocellular intimal proliferation before the patient's death.
肺肿瘤血栓性微血管病（PTTM）是一种与恶性肿瘤相关的致命性呼吸系统并发症；我们在此报告一例由转移性前列腺癌引起的PTTM病例。一名81岁的日本男性出现呼吸困难。高分辨率计算机断层扫描（HRCT）显示双侧肺野弥漫性磨玻璃影。肺微血管抽吸细胞学检查发现前列腺癌细胞。由于高度怀疑为PTTM，立即进行了多西他赛化疗。他的呼吸状况和HRCT表现暂时改善，但入院约6周后死亡。尸检显示小肺动脉纤维细胞内膜增生，证实为前列腺癌所致的PTTM。正如本病例一样，在患者死亡前，往往难以确定是否存在肿瘤栓塞以及纤维细胞内膜增生。
