内容紹介
A Case of Stage Ⅳ Breast Cancer with Long-Term Survival by Chemotherapy Developing Pulmonary Tumor Thrombotic Microangiopathy during the Treatment Course
Summary
Pulmonary tumor thrombotic microangiopathy(PTTM)caused by pulmonary artery microscopic tumor emboli and fibrocellular and/or fibromuscular proliferation leads to progressive pulmonary hypertension and respiratory failure. The prognosis is extremely poor and most patients die shortly after onset. We report a patient with Stage Ⅳ breast cancer and long-term survival who developed PTTM during chemotherapy treatment. A 63-year-old woman with multiple metastases in her cerebellum, bone, lung, and lymph node after left breast conserving surgery started to experience dyspnea and malaise 7 years after the surgery. Two months later, she was urgently admitted to hospital because of respiratory failure and was diagnosed with pulmonary hypertension. However, pulmonary thrombosis and tumor thrombus were not observed. We clinically diagnosed her with PTTM and administered chemotherapy in addition to treatment for pulmonary hypertension. Her medical condition improved gradually and she survived for the subsequent 2 years. When observing progressive hypoxia and pulmonary hypertension without obvious pulmonary embolism findings on imaging, PTTM should be considered. Early diagnosis and immediate induction of chemotherapy for primary disease can improve the survival of patients with PTTM.
要旨
pulmonary tumor thrombotic microangiopathy(PTTM)は肺動脈微小腫瘍塞栓により進行性肺高血圧症や呼吸不全を呈し,ほとんどが発症後短期間で死亡する予後不良の病態である。われわれは,乳癌治療経過中にPTTMを発症したが,がんの薬物治療により長期生存を得られた1例を経験したので報告する。症例は63歳,女性。左乳癌術後の多発転移再発に対して放射線治療および内分泌治療を施行されていたが,術後7年目に肺高血圧症による呼吸不全のため緊急入院となった。胸部造影CT検査では血栓腫瘍栓を認めず,病歴と検査結果よりPTTMと診断した。肺高血圧症の治療に加えて化学療法を施行したところ病状の改善を認め,3年以上にわたり長期生存を得られている。担癌患者に突然発症した肺高血圧症で画像上明らかな肺血栓塞栓所見を認めない場合,PTTMを疑い早期にがん薬物治療を行うことで救命できる可能性がある。
目次
Summary
Pulmonary tumor thrombotic microangiopathy(PTTM)caused by pulmonary artery microscopic tumor emboli and fibrocellular and/or fibromuscular proliferation leads to progressive pulmonary hypertension and respiratory failure. The prognosis is extremely poor and most patients die shortly after onset. We report a patient with Stage Ⅳ breast cancer and long-term survival who developed PTTM during chemotherapy treatment. A 63-year-old woman with multiple metastases in her cerebellum, bone, lung, and lymph node after left breast conserving surgery started to experience dyspnea and malaise 7 years after the surgery. Two months later, she was urgently admitted to hospital because of respiratory failure and was diagnosed with pulmonary hypertension. However, pulmonary thrombosis and tumor thrombus were not observed. We clinically diagnosed her with PTTM and administered chemotherapy in addition to treatment for pulmonary hypertension. Her medical condition improved gradually and she survived for the subsequent 2 years. When observing progressive hypoxia and pulmonary hypertension without obvious pulmonary embolism findings on imaging, PTTM should be considered. Early diagnosis and immediate induction of chemotherapy for primary disease can improve the survival of patients with PTTM.
要旨
pulmonary tumor thrombotic microangiopathy(PTTM)は肺動脈微小腫瘍塞栓により進行性肺高血圧症や呼吸不全を呈し,ほとんどが発症後短期間で死亡する予後不良の病態である。われわれは,乳癌治療経過中にPTTMを発症したが,がんの薬物治療により長期生存を得られた1例を経験したので報告する。症例は63歳,女性。左乳癌術後の多発転移再発に対して放射線治療および内分泌治療を施行されていたが,術後7年目に肺高血圧症による呼吸不全のため緊急入院となった。胸部造影CT検査では血栓腫瘍栓を認めず,病歴と検査結果よりPTTMと診断した。肺高血圧症の治療に加えて化学療法を施行したところ病状の改善を認め,3年以上にわたり長期生存を得られている。担癌患者に突然発症した肺高血圧症で画像上明らかな肺血栓塞栓所見を認めない場合,PTTMを疑い早期にがん薬物治療を行うことで救命できる可能性がある。