Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases

Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy h...

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Autores principales:	Naoki Kawakami, Tomohiro Moriya, Rina Kato, Kentaro Nakamura, Hiroaki Saito, Yoko Wakai, Kazuhito Saito, Mai Sakashita
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Pulmonary tumor thrombotic microangiopathy Early gastric cancer Signet ring cell carcinoma Endoscopy Imatinib Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/0d25dee140f346c3a2aef217d4721b60
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spelling	oai:doaj.org-article:0d25dee140f346c3a2aef217d4721b602021-11-14T12:16:54ZPulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases10.1186/s12876-021-02009-81471-230Xhttps://doaj.org/article/0d25dee140f346c3a2aef217d4721b602021-11-01T00:00:00Zhttps://doi.org/10.1186/s12876-021-02009-8https://doaj.org/toc/1471-230XAbstract Background Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported. Case presentation A previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer. Conclusions Despite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable.Naoki KawakamiTomohiro MoriyaRina KatoKentaro NakamuraHiroaki SaitoYoko WakaiKazuhito SaitoMai SakashitaBMCarticlePulmonary tumor thrombotic microangiopathyEarly gastric cancerSignet ring cell carcinomaEndoscopyImatinibDiseases of the digestive system. GastroenterologyRC799-869ENBMC Gastroenterology, Vol 21, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pulmonary tumor thrombotic microangiopathy Early gastric cancer Signet ring cell carcinoma Endoscopy Imatinib Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Pulmonary tumor thrombotic microangiopathy Early gastric cancer Signet ring cell carcinoma Endoscopy Imatinib Diseases of the digestive system. Gastroenterology RC799-869 Naoki Kawakami Tomohiro Moriya Rina Kato Kentaro Nakamura Hiroaki Saito Yoko Wakai Kazuhito Saito Mai Sakashita Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
description	Abstract Background Pulmonary tumor thrombotic microangiopathy (PTTM), a rare manifestation of metastatic cancer with poor prognosis, is characterized by subacute/acute fatal pulmonary hypertension. The main cause of PTTM is gastric cancer, and cases of early gastric cancer confirmed using autopsy have been reported. Moreover, several cases of early gastric cancer that are undetectable on endoscopy or macroscopic postmortem examination have been reported. Case presentation A previously healthy 50-year-old man presented with progressive dyspnea and cough for 1 month. Echocardiography suggested pulmonary hypertension. Computed tomography revealed diffuse lymphadenopathy, whereas blood work revealed an elevation in several serum tumor marker levels. Despite normal upper endoscopic findings, a presumptive diagnosis of PTTM due to gastric cancer was made based on pathological findings of cervical lymph node biopsy, which indicated signet ring cell carcinoma. Imatinib and tegafur/gimeracil/oteracil plus oxaliplatin therapy were started on day 7. The patient’s condition was initially stable. However, his symptoms suddenly progressed, and the patient died on day 8. Macroscopic postmortem examination revealed no abnormal gastric wall findings. Microscopically, PTTM was confirmed, and multiple serial sections of the stomach revealed early gastric cancer. Conclusions Despite normal endoscopic findings, micro-occult gastric cancer can lead to PTTM. Physicians should be aware of this disease presentation. Taking prompt action is needed when PTTM is suspected, even if the patient appears stable.
format	article
author	Naoki Kawakami Tomohiro Moriya Rina Kato Kentaro Nakamura Hiroaki Saito Yoko Wakai Kazuhito Saito Mai Sakashita
author_facet	Naoki Kawakami Tomohiro Moriya Rina Kato Kentaro Nakamura Hiroaki Saito Yoko Wakai Kazuhito Saito Mai Sakashita
author_sort	Naoki Kawakami
title	Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
title_short	Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
title_full	Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
title_fullStr	Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
title_full_unstemmed	Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
title_sort	pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases
publisher	BMC
publishDate	2021
url	https://doaj.org/article/0d25dee140f346c3a2aef217d4721b60
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Pulmonary tumor thrombotic microangiopathy in occult early gastric cancer that was undetectable on upper endoscopy: a case report and review of similar cases

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