Tumour microemboli as a cause of death in a patient with metastatic urothelial carcinoma

Abstract

Tumour microemboli are a rare but underdiagnosed complication of end-stage cancer. Diagnosis is challenging and most cases are diagnosed retrospectively at autopsy. Pulmonary tumour microemboli can cause progressive shortness of breath and respiratory failure. They may present in an insidious manner, similar to multiple thromboemboli. This case study reports a patient with a past history of urothelial carcinoma, who presented with increasing dyspnoea and hypoxia. He was found to have pulmonary hypertension, enlarged abdominal lymph nodes and deranged liver function tests. He died suddenly 4 days after admission. At autopsy the patient was found to have tumour microemboli throughout the lungs and liver, in addition to urothelial carcinoma present in the left retroperitoneal lymph nodes, left adrenal gland and bone marrow. Antemortem recognition of tumour microemboli can prevent over-investigation and anticoagulation of patients who may be more appropriate for palliative care.