Shiraiwa Yuri, Taniguchi Yuri, Hyoudou Mari, Shiba Aya, Aga Masaharu, Miyazaki Kazuhito, Hamakawa Yusuke, Misumi Yuki, Agemi Yoko, Shimokawa Tsuneo, Hasegawa Chie, Hayashi Hiroyuki, Okamoto Hiroaki
Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawa-nishimachi, Kanagawa-ku, Yokohama, Kanagawa, 221-0855, Japan.
Department of Pathology, Yokohama Municipal Citizen's Hospital, Japan.
Respir Med Case Rep. 2022 Mar 15;37:101631. doi: 10.1016/j.rmcr.2022.101631. eCollection 2022.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare manifestation of malignancy. The antemortem diagnosis is difficult, since patients present with rapidly progressive symptoms. We recently observed a case of PTTM following lymphedema of the lower extremities. We did not reach a diagnosis, even after performing BAL and TBLB. The patient manifested pulmonary hypertension and died on the 9th day of admission. Autopsy revealed a tumor embolism in the pulmonary arterioles accompanied by fibrocellular epithelial cell proliferation, but the primary organ was not identified. To our knowledge, this is the first reported case of PTTM with lymphedema.
肺肿瘤血栓性微血管病（PTTM）是恶性肿瘤的一种罕见表现。生前诊断困难，因为患者表现出快速进展的症状。我们最近观察到一例下肢淋巴水肿后发生PTTM的病例。即使进行了支气管肺泡灌洗（BAL）和经支气管肺活检（TBLB），我们仍未做出诊断。该患者出现肺动脉高压，并在入院第9天死亡。尸检显示肺小动脉有肿瘤栓子，伴有纤维细胞性上皮细胞增生，但未确定原发器官。据我们所知，这是首例有淋巴水肿的PTTM报道病例。
