Department of Breast and Endocrine Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan.
Tokai J Exp Clin Med. 2022 Sep 20;47(3):131-135.
Herein, we report a case of a patient with recurrent breast cancer who was diagnosed antemortem with pulmonary tumor thrombotic microangiopathy (PTTM) using wedge aspiration cytology of the pulmonary artery after breast cancer surgery.
The patient was a 50-year-old woman who underwent mastectomy and axillary lymph node dissection for stage IIIA (T3N2M0) triple-negative left breast cancer. Postoperative follow-up was performed with radiotherapy and anticancer chemotherapy. Seventeen months after the surgery, the patient was hospitalized for right heart failure and diagnosed with pulmonary arterial hypertension. The patient was diagnosed with PTTM following the detection of malignant cells in the pulmonary artery using wedge aspiration cytology. Anti-pulmonary hypertension therapy was administered; however, the patient did not respond and died 26 days after admission. Autopsy revealed multiple microscopic tumor emboli in the pulmonary artery. In portions of the pulmonary artery without embolization, fibro-cellular intimal hyperplasia and stenosis were observed. Tumor embolism was expressed for CK7+/CK20-, consistent with the primary breast cancer.
Since the primary pathophysiology of PTTM entails narrowing due to fibro-cellular intimal hyperplasia rather than multiple tumor thrombi, the efficacy of chemotherapy combined with vasodilators is discussed.
本研究报告了一例乳腺癌复发患者，该患者在乳腺癌手术后通过肺动脉楔形抽吸细胞学检查被诊断为肺肿瘤血栓性微血管病（PTTM）。
患者为 50 岁女性，因 IIIA 期（T3N2M0）三阴性左乳腺癌行乳房切除术和腋窝淋巴结清扫术。术后采用放疗和抗癌化疗进行随访。术后 17 个月，患者因右心衰竭住院，并诊断为肺动脉高压。通过肺动脉楔形抽吸细胞学检查发现恶性细胞，患者被诊断为 PTTM。给予抗肺动脉高压治疗，但患者无反应，入院后 26 天死亡。尸检显示肺动脉内有多个显微镜下的肿瘤栓子。在没有栓塞的肺动脉部分，观察到纤维细胞内膜增生和狭窄。肿瘤栓塞呈 CK7+/CK20-表达，与原发性乳腺癌一致。
由于 PTTM 的主要病理生理学是由于纤维细胞内膜增生导致狭窄，而不是多个肿瘤血栓，因此讨论了化疗联合血管扩张剂的疗效。
