Initial diagnosis and successful treatment of pulmonary tumor embolism manifesting as the first clinical sign of prostatic adenocarcinoma.

• 发表时间: 2020
• 来源期刊: Respir Med Case Rep
• DOI: 10.1016/j.rmcr.2020.101163
• PMID: 32714825
• 文章类型: Case Reports
• 作者列表: Petnak T,Suwatanapongched T,Klaisuban W,Nitiwarangkul C,Pornsuriyasak P

关键词: CT, Computed tomography; Computed tomography; PDGF, Platelet-derived growth factor; PLC, Pulmonary lymphangitic carcinomatosis; PSA, Prostatic specific antigen; PTE, Pulmonary tumor embolism; PTTM, Pulmonary tumor thrombotic microangiopathy; Prostate cancer; Pulmonary lymphangitic carcinomatosis; Pulmonary tumor embolism; VEGF, Vascular endothelial growth factor

Abstract

Although pulmonary tumor embolism (PTE) is a well-recognized end-stage form of pulmonary metastases at postmortem examination, the entity is rarely the first clinical sign of prostate cancer. Diagnosis of this condition in patients who have no previous history of malignancy is a challenge. Herein, we reported a 79-year-old man presented with progressive, unexplained dyspnea on exertion. Microscopic PTE coinciding with pulmonary lymphangitic carcinomatosis were readily recognized based on the presence of multifocal dilatation and beading of the peripheral pulmonary arteries with thickening of the bronchial walls and interlobular septa on the initial thin-section chest CT images. Pathologic examination of the transbronchial lung biopsy specimen revealed tumor emboli occluding both the small muscular pulmonary arteries and lymphatic vessels. These tumor cells were positive for prostatic specific antigen on immunohistochemical staining. The final diagnosis of prostatic adenocarcinoma was confirmed. Remarkable clinical and radiographic improvement was achieved following bilateral orchiectomies and anti-androgen treatment.