Pulmonary Tumor Embolism Research Articles

A rare cause of fatal right heart failure

Microscopic pulmonary tumor embolism (MPTE) is an uncommon cause of dyspnea in patients with cancer and one of the most difficult to diagnose. MPTE is a syndrome that is pathologically characterized by the occlusion of small pulmonary arteries and arterioles by aggregates of tumor cells. Because the clinical picture resembles that of thromboembolic disease, it is rarely recognized before death. The most common clinical symptom is subacute progressive dyspnea over weeks to months. We recently observed a case of MPTE of exceptional interest as the patient was under aggressive anticoagulant treatment and developed fulminant pulmonary hypertension with fatal right heart failure.

Intracavitary cardiac metastasis and pulmonary tumor emboli of choriocarcinoma: The first case diagnosed and treated without surgical intervention

Background. Choriocarcinoma mostly metastasizes to lung parenchyma. Its pulmonary tumor embolism and cardiac metastasis are very rarely encountered, of which antemortem diagnosis is even more rare. Case. To our knowledge, we present the first case of intracavitary cardiac metastasis and pulmonary tumor emboli of choriocarcinoma diagnosed and treated without any surgical intervention. Multi-agent chemotherapy led to almost complete regression of cardiac and pulmonary lesions and normalization of β-hCG levels. Conclusion. Cardiac metastasis of choriocarcinoma must be kept in mind for cases of cardiac mass in reproductive age women, especially when history and clinical presentation are suggestive for gestational trophoblastic disease. As the tumor is highly sensitive, chemotherapy together with biochemical and radiological monitoring constitutes an effective treatment modality if cardiopulmonary functions are not deteriorating.

Intimal sarcoma of the pulmonary artery: Report of an autopsy case

Primary pulmonary artery sarcomas (PASs) are rare and lethal tumors. They are easily misdiagnosed as chronic pulmonary embolism, mediastinal mass or tumor emboli, which delay a proper treatment. Although the advanced technologies are now increasingly being used, their diagnosis is usually hard to establish preoperatively at the present time. We report here a case of a 68-year-old female with PAS with lung metastases, who firstly presented with symptoms of common cold and anemia. Although a PAS had been suspected, the final diagnosis of pulmonary intimal sarcoma was made only postoperatively by histological and immunohistochemical examination. The patient died 8 months after the operation because of tumor growth progression, despite adjuvant chemotherapy and radiation therapy. Although pulmonary intimal sarcomas are usually of poorly differentiated mesenchymal malignancy, most reported cases are immunohistochemically positive for vimentin, α-smooth muscle actin (SMA), and/or desmin, therefore resembling leiomyosarcomas. However, the diagnosis of leiomyosarcoma should not be made on the basis of immunostains in the absence of typical morphologic features, and PAS, like the present case, should be more appropriately classified as intimal sarcoma according to the new WHO Classification of Tumours of Soft Tissue and Bone published in 2002.

Pulmonary thromboembolism in children

Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients.

Pulmonary embolization as primary manifestation of hepatocellular carcinoma with intracardiac penetration: A case report

Intracardiac manifestation of hepatocellular carcinoma (HCC) is a rare condition and an uncommon finding even at autopsy. Pulmonary tumor embolism as a presenting feature of HCC has been published only twice previously. In our case report, a 63-year-old man presented with high fever and six episodes of recurrent pneumonias during the last half year. Echocardiography was performed, a solid mass was found in the right atrium. Transesophageal echocardiography proved a tumor mass in the inferior vena cava (IVC) extending into the right atrium, abdominal ultrasound revealed tumor mass in the IVC and a solid tumor in the liver. Combined liver and heart surgery was attempted in order to remove the tumor mass from both the liver and the right atrium. Acute cor pulmonale occurred during tumor removal from the right atrium and the patient expired. In addition to local factors the possibility of embolization should arise in the background of recurrent pneumonia. Occult carcinoma must be included in possible causes of recurrent pulmonary embolism. Searching for primary malignancy should include HCC as frequent cause of hypercoagulability. In case of HCC, echocardiography is suggested because of the possibility of expansion in IVC or right atrium and tumor-embolization.

Bilateral pulmonary artery tumour emboli from renal carcinoma

A 53-year-old male presented with shortness of breath and dyspnoea on exertion, which he noticed for several months. CT of the chest showed bilateral main pulmonary artery emboli with extension into the interlobar and segmental arteries, as well as several pulmonary infarcts figure a). An abdominal CT scan showed a renal mass 9·8×8·6 cm) in the right kidney that xtended into the nferior vena cava cranially to the level of the hepatic vasculature (figure b). A bilateral pulmonary embolectomy followed by a right nephrectomy with caval thrombectomy were done in the same surgical setting.

A case report-A long-term implantable temporary caval filter (Tempofilter (R) II) for prevention of pulmonary tumor embolism in a patient with testicular tumor extended to inferior vena cava

A case report-A long-term implantable temporary caval filter (Tempofilter (R) II) for prevention of pulmonary tumor embolism in a patient with testicular tumor extended to inferior vena cava

Tumor Embolism as a Cause of an Unexpected Death: A Case Report

The primary causes of deaths for individuals with rare cancers can be difficult to diagnose clinically. Often, the symptoms implicate a variety of factors, and an autopsy is thus required to obtain the correct diagnosis. This study analyzes the death of a 45-year-old woman who reportedly died from an acute pulmonary dysfunction. The patient had been treated with antibiotics for three months for intractable pneumonia. Suspicious coin lesions detected by chest X-ray prompted a clinical clarification; however, no final diagnosis was made. The autopsy revealed a bulky thyroid tumor with venous invasion, leading to a massive pulmonary tumor embolism. Furthermore, microscopy identified the tumor as a rare pleomorphic myxoid sarcoma. Thus, the patient died of a large pulmonary tumor embolism originating from this rare sarcoma, and not of acute pulmonary dysfunction of any other means.

Pulmonary Tumor Embolism Presenting As A Complication of Adenoid Cystic Carcinom

Pulmonary Tumor Embolism Presenting As A Complication of Adenoid Cystic Carcinom

Pulmonary medicine and palliative care

Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.

下大静脈腫よう塞栓を伴う腎腫よう患者の手術に際し，一時的下大静脈フィルタカテーテルが有効であった１症例

下大静脈腫よう塞栓を伴う腎腫よう患者の手術に際し，一時的下大静脈フィルタカテーテルが有効であった１症例

Microscopic Pulmonary Tumor Emboli: An Unusual Presentation of Breast Cancer.

We report a rare case of microscopic pulmonary tumor embolism from breast cancer in a young woman with no prior medical history. The patient presented with progressive dyspnea and questionable abnormalities of the left breast and axilla on physical examination. Results of an axillary lymph node biopsy and subsequent radiologic studies raised the possibility of either microscopic pulmonary tumor emboli or lymphangitic spread of cancer as a cause of the dyspnea. The patient died due to advanced breast cancer confirmed at autopsy despite chemotherapy.

A Massive Pulmonary Tumor Embolism After Surgical Manipulation and Biopsy of a Pelvic Mass

A Massive Pulmonary Tumor Embolism After Surgical Manipulation and Biopsy of a Pelvic Mass

Sudden death from massive pulmonary tumor embolism due to hepatocellular carcinoma

Massive pulmonary embolism in cancer patients can be due to detached thrombi or tumor. Pulmonary tumor embolism is often undiagnosed antemortem. We report a 52-year-old Chinese man admitted for management of hepatocellular carcinoma (HCC). Computerized tomography showed tumor involvement of hepatic vein and inferior vena cava. He died suddenly on the day of admission. At autopsy the main pulmonary arteries of both lungs were blocked by large tumor emboli, the immediate cause of death. Although rapid death in patients with HCC is usually caused by intraperitoneal hemorrhage from spontaneous rupture of tumor, massive pulmonary tumor embolism should also be considered in these patients, especially when antemortem evidence of hepatic vein and/or inferior vena cava invasion is present.

COMPLETE RADICAL NEPHRECTOMY AND VENA CAVAL THROMBECTOMY DURING CIRCULATORY ARREST

A modification of radical nephrectomy for renal carcinoma and vena caval tumor thrombectomy for supradiaphragmatic tumor extension under hypothermic circulatory arrest is presented. Nephrectomy was performed during the circulatory arrest time in 16 consecutive patients during the last 4 years. Average hypothermic circulatory arrest time increased by 6 minutes. By elimination of manipulation of tumor and thrombus before circulatory arrest potential thrombus fragmentation and embolization were minimized. There were no significant differences in blood loss or complications compared to a prior series of 10 patients undergoing the procedure using conventional techniques. Performance of complete radical nephrectomy along with venal caval embolectomy during circulatory arrest increases the safety of the procedure without significant morbidity.

Pulmonary Tumor Embolism From Primary Cardiac B-Cell Lymphoma

We report the case of a 54-year-old man with pulmonary embolism during convalescence from "idiopathic" pericarditis. A transthoracic echocardiographic examination indicated a large mass within the right atrium. Subsequently, he died from refractory hypotension. On autopsy, two large whitish nodules were found in the right atrium; there was also nodular epicardial infiltration. Both lungs showed multiple, grossly visible tumor emboli with pulmonary infarction and no evidence of conventional thromboembolism. This is the first report of pulmonary tumor embolism due to large cell B-cell primary cardiac lymphoma. Refractory unexplained pericardial effusion, pulmonary embolism without risk factors for venous thrombosis, and/or the existence of a mass in the right heart should arouse clinical suspicion for this rare malignancy.

The Checkerboard Sign

Pulmonary tumor emboli, which are uncommon, are found in approximately 2.4% to 26% of autopsy cases. They can be divided into two classes: massive or sub-massive and multiple pulmonary tumor microemboli. Clinically, they manifest in the same way as do thromboembolic emboli. Scintigraphically, pulmonary tumor microemboli appear as small peripheral subsegmental perfusion-ventilation mismatched defects or have a checkerboard appearance (the checkerboard sign). Recognition of pulmonary tumor microemboli is important, because therapy does not involve heparin treatment, as with thromboembolic disease, but rather is chemotherapy.

Pulmonary Tumor Microembolism

Pulmonary tumor embolism is an often missed antemortem diagnosis in patients with cancer and respiratory failure. Although rare, this complication is an important cause of additional morbidity. Referred for radionuclide pulmonary perfusion and ventilation scintigraphy, a typical pattern of multiple subsegmental peripheral defects on perfusion lung scanning without matching ventilation defects, suggesting a high probability of pulmonary thromboembolism, often leads to false conclusions. We present a case of bilateral multiple subsegmental mismatched defects in lung ventilation perfusion scintigraphy, where autopsy confirmed the diagnosis of pulmonary tumor embolism, secondary to an undifferentiated ductal type adenocarcinoma of the pancreas. Pulmonary tumor embolism is an entity to keep in mind in patients treated for carcinoma presenting with (sub) acute dyspnea.

Pulmonary Tumour Embolism Complicating a Case of Leiomyosarcoma

Patient. A case of peripheral leiomyosarcoma presenting with features of pulmonary thromboembolism is described. Discussion. Persistence of the embolus despite triple-armed thrombolytic therapy and the presence of intravascular tumour invasion suggest the rare entity of pulmonary tumour embolism from a leiomyosarcoma.

Pulmonary tumor embolism.

Among the various causes of morbidity and mortality in patients with cancer, perhaps the least well described is tumor embolism. This condition was first documented in 1897 by Schmidt (1), but since then most information on this topic has been in the form of case reports or autopsy series. The paucity of information is due in part to the failure to recognize this condition antemortem. A significant proportion of such patients are diagnosed as having pulmonary thromboembolism and are treated with anticoagulation. Although recent studies have attempted to diagnose and differentiate malignant embolism from thromboembolism, lung biopsy remains the procedure of choice. These studies as well as the clinical manifestations of tumor embolism are the focus of this report. Although the specific cellular and molecular mechanisms of tumor embolism are not yet well understood, our onderstanding of the phenomenon has improved substantially in the last decade. Tumor cells access the systemic circulation via active invasion of small veins, venules, or the tumor's own microvasculature (2). The pulmonary vascular bed receives the entire cardiac output and filters any cell with a diameter of 10 μm or greater (3). Most tumor cells in the circulation are destroyed either by mechanical and shear forces of the microcirculation or by the various effector cells of the immune system. In fact, less than 1% of tumor cells that enter the circulation survive the passage through the lungs (4-6). The surviving tumor cells have a wide spectrum of biological fates and clinical manifestations: (1) Tumor cells may remain asymptomatic. In fact, autopsy review studies have shown that 18% to 68% of tumor emboli are discovered as incidental findings (7, 8). (2) Tumor cells may present a clinical picture similar to thromboembolic disease (9-12). (3) Finally, neoplastic cells that reach the capillaries may traverse the endothelium and form a potential focus of metastasis (4, 13). Current evidence has shown that the simple entrapment of cells in the pulmonary vasculature is insufficient for metastasis. Tumor cells must (1) adhere to lung-specific adhesion molecules such as laminin and fibronectin located on the vascular endothelium and basement membrane, (2) produce enzymes that degrade elastin, a molecule which is preferentially located in the lung extracellular matrix, and (3) be able to grow in association with lung-specific growth factors. The subject of metastasis formation is beyond the scope of this report but has been reviewed elsewhere (14). This article will review the clinical and pathological manifestations of pulmonary tumor embolism, focusing mainly on the patient with cancer presenting with dyspnea and no obvi-