Jolivet J, Giroux L, Laurin S, Gruber J, Bettez P, Band P R
Cancer Treat Rep. 1983 May;67(5):429-34.
Following gastrectomy for locally advanced adenocarcinomas, three patients developed microangiopathic hemolytic anemia and renal failure shortly after completing courses of adjuvant chemotherapy with mitomycin and 5-FU. These complications progressed despite cessation of chemotherapy, and all three patients died of noncardiogenic pulmonary edema precipitated in two cases by blood transfusions. At autopsy, two patients had no residual carcinoma and all had a diffuse microangiopathy involving mainly the kidneys and lungs. There was intimal hyperplasia of many arterioles sometimes associated with complete occlusion of the lumen, prominent nuclear atypia in many capillary cells, and numerous capillary fibrin thrombi. Direct immunofluorescence studies revealed extensive fibrinogen-fibrin deposits in the vascular lesions. Chemotherapy-induced microangiopathic hemolytic anemia and renal failure may predispose patients to fatal episodes of noncardiogenic pulmonary edema that can be triggered by blood transfusions.
对于局部晚期腺癌患者进行胃切除术后，三名患者在完成丝裂霉素和5-氟尿嘧啶辅助化疗疗程后不久出现微血管病性溶血性贫血和肾衰竭。尽管停止了化疗，这些并发症仍在进展，所有三名患者均死于非心源性肺水肿，其中两例是由输血诱发的。尸检时，两名患者无残留癌，所有患者均有主要累及肾脏和肺部的弥漫性微血管病。许多小动脉内膜增生，有时伴有管腔完全闭塞，许多毛细血管细胞有明显的核异型性，并有大量毛细血管纤维蛋白血栓形成。直接免疫荧光研究显示血管病变中有广泛的纤维蛋白原-纤维蛋白沉积。化疗诱导的微血管病性溶血性贫血和肾衰竭可能使患者易发生由输血引发的致命性非心源性肺水肿。
