Kim Tae-Se, Ahn Soomin, Chang Sung-A, Lim Sung Hee, Min Byung-Hoon, Min Yang Won, Lee Hyuk, Rhee Poong-Lyul, Kim Jae J, Lee Jun Haeng
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Gastric Cancer. 2025 Apr;25(2):276-284. doi: 10.5230/jgc.2025.25.e1.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal complication of gastric cancer (GC). This study aimed to evaluate the clinical characteristics, outcomes, and immunohistochemical profiles of patients with GC-induced PTTM.
From 2011 to 2023, 8 patients were clinically diagnosed with PTTM associated with GC antemortem. Clinical features and outcomes were reviewed, and immunohistochemical staining for c-erbB-2, MutL protein homolog 1, and programmed cell death ligand-1 was performed.
The median patient age was 56 years (range, 34-66 years). In all the patients, the tumors exhibited either ulceroinfiltrative or diffusely infiltrative gross morphology. The median tumor size was 5.8 cm (range, 2.0 cm-15.0 cm). Poorly differentiated adenocarcinoma was the most common histological type (6/8, 75%), followed by signet ring cell carcinoma (1/8, 12.5%) and moderately differentiated adenocarcinoma (1/8, 12.5%). Chest computed tomography revealed ground-glass opacities (7/8, 87.5%) or tree-in-bud signs (2/8, 25.0%) without definite evidence of pulmonary thromboembolism. Disseminated intravascular coagulation was present in 62.5% (5/8) of the patients diagnosed with PTTM. C-erbB-2 was positive in one patient (1/8, 12.5%). One patient who received palliative chemotherapy after developing PTTM survived for 35 days, whereas the other 7 patients who did not receive chemotherapy after developing PTTM survived for 7 days or less after PTTM diagnosis.
Most patients with GC-induced PTTM had an undifferentiated-type histology, infiltrative morphology, and extremely poor survival. Palliative chemotherapy may benefit patients with GC-induced PTTM; however, further studies are needed to explore the potential of targeted therapy in these patients.
肺肿瘤血栓性微血管病（PTTM）是胃癌（GC）的一种致命并发症。本研究旨在评估GC所致PTTM患者的临床特征、预后及免疫组化特征。
2011年至2023年，8例患者生前临床诊断为与GC相关的PTTM。回顾临床特征和预后，并进行c-erbB-2、MutL蛋白同源物1和程序性细胞死亡配体-1的免疫组化染色。
患者中位年龄为56岁（范围34 - 66岁）。所有患者肿瘤大体形态均表现为溃疡浸润性或弥漫浸润性。肿瘤中位大小为5.8 cm（范围2.0 cm - 15.0 cm）。低分化腺癌是最常见的组织学类型（6/8，75%），其次是印戒细胞癌（1/8，12.5%）和中分化腺癌（1/8，12.5%）。胸部计算机断层扫描显示磨玻璃影（7/8，87.5%）或树芽征（2/8，25.0%），无明确的肺血栓栓塞证据。62.5%（5/8）诊断为PTTM的患者存在弥散性血管内凝血。c-erbB-2在1例患者中呈阳性（1/8，12.5%）。1例PTTM发生后接受姑息化疗的患者存活了35天，而其他7例PTTM发生后未接受化疗的患者在PTTM诊断后存活7天或更短时间。
大多数GC所致PTTM患者具有未分化型组织学、浸润性形态且生存极差。姑息化疗可能对GC所致PTTM患者有益；然而，需要进一步研究探索这些患者的靶向治疗潜力。
