Suyama N, Mashimoto H, Araki J, Asai S, Ikeno Y, Ikeda T
Department of Internal Medicine, Sasebo City General Hospital, Nagasaki, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 May;32(5):491-6.
Pulmonary tumor embolism is a common finding at autopsy but is difficult to diagnose clinically antemortem. We report an autopsy case of urinary bladder carcinoma associated with tumor emboli of the pulmonary arteries and subsequent pulmonary infarctions. An eighty-six-year-old man with bloody sputum showed multiple infiltrates on chest X-ray and multiple pleural based parenchymal lesions with truncated apex on computed tomography. The patient had a history of radiation therapy against urinary bladder carcinoma two years earlier. Transitional type carcinoma cells were identified from a urine sample obtained on admission. Three weeks later, the patient developed subacute cor pulmonale and died in severe respiratory distress. Postmortem examination revealed primary carcinoma of the urinary bladder. Multiple tumor emboli of pulmonary arteries and subsequent pulmonary infarctions were visible microscopically. There was a large amount of effusion in both the pleural and the abdominal space. The heart contained focal scarring and mild right ventricular hypertrophy and there was congestion of the lungs, liver, kidneys and spleen. Pulmonary tumor embolization may present at any stage of the patient's illness but rarely causes subsequent pulmonary infarctions. Cytologic examination of blood samples obtained from Swan-Ganz catheters may be useful in the diagnosis of tumor embolization.
肺肿瘤栓塞在尸检中很常见，但生前临床诊断困难。我们报告一例膀胱癌合并肺动脉肿瘤栓子及随后发生肺梗死的尸检病例。一名86岁男性，有咯血症状，胸部X线显示多处浸润影，计算机断层扫描显示多处胸膜下实质病变，尖端截断。该患者两年前有膀胱癌放疗史。入院时采集的尿液样本中发现移行型癌细胞。三周后，患者发展为亚急性肺心病，死于严重呼吸窘迫。尸检发现原发性膀胱癌。显微镜下可见多处肺动脉肿瘤栓子及随后的肺梗死。胸膜腔和腹腔有大量积液。心脏有局灶性瘢痕形成和轻度右心室肥厚，肺、肝、肾和脾有淤血。肺肿瘤栓塞可在患者疾病的任何阶段出现，但很少导致随后的肺梗死。从 Swan-Ganz 导管采集的血样进行细胞学检查可能有助于肿瘤栓塞的诊断。
