The Journal of the Japanese Respiratory Society ONLINE JOURNAL
ABSTRACT
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Article in Japanese
Case Report
An autopsy case of gastric cancer presenting as acute respiratory failure due to pulmonary tumor thrombotic microangiopathy with concomitant high serum level of vascular endothelial growth factor-D
Akio Takezaki1)4), Toru Arai1)2), Yoshikazu Inoue2), Akihide Nishiyama1), Masanori Kitaichi2)3) and Seiji Hayashi1)
1)Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center
2)Department of Diffuse Lung Diseases and Respiratory Failure, National Hospital Organization Kinki-Chuo Chest Medical Center
3)Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center
4)Institute of Health Biosciences, The University of Tokushima Graduate School
ABSTRACT
A 49-year-old man consulted our hospital several days after the onset of dyspnea and was admitted because it rapidly exacerbated 9 days after presentation. Diffuse centrilobular micronodular shadows and diffuse opacities in all lung fields were noted on high-resolution computed tomography of the chest. Severe pulmonary hypertension and dilatation of the right ventricle was observed on echocardiography. Although there was no evidence of thrombus in the central portion of the pulmonary artery or deep veins of the lower limbs, the patient's respiratory insufficiency rapidly progressed and he died about 14 hours after admission. A postmortem examination revealed widespread gastric cancer and tumor emboli in the pulmonary arterioles, complicated with intraluminal organization, which is consistent with pulmonary-tumor thrombotic microangiopathy (PTTM). His serum level of vascular endothelial growth factor-D (VEGF-D) was elevated, but VEGF-D was not detected by immunohistological staining. A possible pathophysiological association with PTTM and VEGF-D should be examined in future studies.
KEYWORDS: Vascular endothelial growth factor, Pulmonary tumor thrombotic microangiopathy, Acute respiratory failure, Pulmonary hypertension, Gastric cancer
RECEIVED: 2011.2.8
JJRS, 49(12): 890-896, 2011
