Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinical entity where tumor cell embolisms in pulmonary circulation induce thrombotic microangiopathy (TMA), respiratory failure, and subacute cor pulmonale. We describe 3 cases of PTTM that presented as the initial manifestation of metasta...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Wolters Kluwer Health
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602432/ https://www.ncbi.nlm.nih.gov/pubmed/25500705 http://dx.doi.org/10.1097/MD.0000000000000219 |
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author | Gainza, Eukene Fernández, Sara Martínez, Daniel Castro, Pedro Bosch, Xavier Ramírez, José Pereira, Arturo Cibeira, María T. Esteve, Jordi Nicolás, Josep M. |
author_facet | Gainza, Eukene Fernández, Sara Martínez, Daniel Castro, Pedro Bosch, Xavier Ramírez, José Pereira, Arturo Cibeira, María T. Esteve, Jordi Nicolás, Josep M. |
author_sort | Gainza, Eukene |
collection | PubMed |
description | Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinical entity where tumor cell embolisms in pulmonary circulation induce thrombotic microangiopathy (TMA), respiratory failure, and subacute cor pulmonale. We describe 3 cases of PTTM that presented as the initial manifestation of metastatic gastric adenocarcinoma with TMA and pulmonary infiltrates. All 3 cases had similar clinical and laboratory features, which included moderate thrombocytopenia without renal failure, hemolysis with extremely high serum lactate dehydrogenase levels, leukoerythroblastosis in peripheral blood smear, altered coagulation tests, lymphadenopathies, and interstitial pulmonary infiltrates. All patients died within 2 weeks of diagnosis. Two cases were initially misdiagnosed as idiopathic thrombotic thrombocytopenic purpura and treated with plasma exchange with no response. One patient had bone marrow infiltration by malignant cells. Autopsies revealed PTTM associated with gastric disseminated adenocarcinoma (signet-ring cell type in 2 patients and poorly differentiated type in 1). PTTM should be considered in the differential diagnosis of patients with fulminant microangiopathic hemolytic anemia, such as atypical thrombotic thrombocytopenic purpura, mainly those with pulmonary infiltrates, disseminated intravascular coagulation, or Trousseau syndrome. |
format | Online Article Text |
id | pubmed-4602432 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-46024322015-10-27 Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature Gainza, Eukene Fernández, Sara Martínez, Daniel Castro, Pedro Bosch, Xavier Ramírez, José Pereira, Arturo Cibeira, María T. Esteve, Jordi Nicolás, Josep M. Medicine (Baltimore) Article Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinical entity where tumor cell embolisms in pulmonary circulation induce thrombotic microangiopathy (TMA), respiratory failure, and subacute cor pulmonale. We describe 3 cases of PTTM that presented as the initial manifestation of metastatic gastric adenocarcinoma with TMA and pulmonary infiltrates. All 3 cases had similar clinical and laboratory features, which included moderate thrombocytopenia without renal failure, hemolysis with extremely high serum lactate dehydrogenase levels, leukoerythroblastosis in peripheral blood smear, altered coagulation tests, lymphadenopathies, and interstitial pulmonary infiltrates. All patients died within 2 weeks of diagnosis. Two cases were initially misdiagnosed as idiopathic thrombotic thrombocytopenic purpura and treated with plasma exchange with no response. One patient had bone marrow infiltration by malignant cells. Autopsies revealed PTTM associated with gastric disseminated adenocarcinoma (signet-ring cell type in 2 patients and poorly differentiated type in 1). PTTM should be considered in the differential diagnosis of patients with fulminant microangiopathic hemolytic anemia, such as atypical thrombotic thrombocytopenic purpura, mainly those with pulmonary infiltrates, disseminated intravascular coagulation, or Trousseau syndrome. Wolters Kluwer Health 2014-11-02 /pmc/articles/PMC4602432/ /pubmed/25500705 http://dx.doi.org/10.1097/MD.0000000000000219 Text en © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins |
spellingShingle | Article Gainza, Eukene Fernández, Sara Martínez, Daniel Castro, Pedro Bosch, Xavier Ramírez, José Pereira, Arturo Cibeira, María T. Esteve, Jordi Nicolás, Josep M. Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature |
title | Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature |
title_full | Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature |
title_fullStr | Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature |
title_full_unstemmed | Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature |
title_short | Pulmonary Tumor Thrombotic Microangiopathy: Report of 3 Cases and Review of the Literature |
title_sort | pulmonary tumor thrombotic microangiopathy: report of 3 cases and review of the literature |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602432/ https://www.ncbi.nlm.nih.gov/pubmed/25500705 http://dx.doi.org/10.1097/MD.0000000000000219 |
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