Abstract：
OBJECTIVE: Herein, we report a case of a patient with recurrent breast cancer who was diagnosed antemortem with pulmonary tumor thrombotic microangiopathy (PTTM) using wedge aspiration cytology of the pulmonary artery after breast cancer surgery.
METHODS: The patient was a 50-year-old woman who underwent mastectomy and axillary lymph node dissection for stage IIIA (T3N2M0) triple-negative left breast cancer. Postoperative follow-up was performed with radiotherapy and anticancer chemotherapy. Seventeen months after the surgery, the patient was hospitalized for right heart failure and diagnosed with pulmonary arterial hypertension. The patient was diagnosed with PTTM following the detection of malignant cells in the pulmonary artery using wedge aspiration cytology. Anti-pulmonary hypertension therapy was administered; however, the patient did not respond and died 26 days after admission. Autopsy revealed multiple microscopic tumor emboli in the pulmonary artery. In portions of the pulmonary artery without embolization, fibro-cellular intimal hyperplasia and stenosis were observed. Tumor embolism was expressed for CK7+/CK20-, consistent with the primary breast cancer.
CONCLUSIONS: Since the primary pathophysiology of PTTM entails narrowing due to fibro-cellular intimal hyperplasia rather than multiple tumor thrombi, the efficacy of chemotherapy combined with vasodilators is discussed.
METHODS: The patient was a 50-year-old woman who underwent mastectomy and axillary lymph node dissection for stage IIIA (T3N2M0) triple-negative left breast cancer. Postoperative follow-up was performed with radiotherapy and anticancer chemotherapy. Seventeen months after the surgery, the patient was hospitalized for right heart failure and diagnosed with pulmonary arterial hypertension. The patient was diagnosed with PTTM following the detection of malignant cells in the pulmonary artery using wedge aspiration cytology. Anti-pulmonary hypertension therapy was administered; however, the patient did not respond and died 26 days after admission. Autopsy revealed multiple microscopic tumor emboli in the pulmonary artery. In portions of the pulmonary artery without embolization, fibro-cellular intimal hyperplasia and stenosis were observed. Tumor embolism was expressed for CK7+/CK20-, consistent with the primary breast cancer.
CONCLUSIONS: Since the primary pathophysiology of PTTM entails narrowing due to fibro-cellular intimal hyperplasia rather than multiple tumor thrombi, the efficacy of chemotherapy combined with vasodilators is discussed.
摘要：
目的：这里，我们报道了一例复发性乳腺癌患者,该患者在乳腺癌手术后使用肺动脉楔形抽吸细胞学检查在死前被诊断为肺肿瘤血栓性微血管病(PTTM).
方法：患者为一名50岁女性，因IIIA期（T3N2M0）三阴性左乳腺癌行乳房切除术和腋窝淋巴结清扫术。术后随访放疗和抗癌化疗。手术后17个月,患者因右心衰竭住院，并诊断为肺动脉高压。使用楔形抽吸细胞学检查在肺动脉中检测到恶性细胞后，患者被诊断为PTTM。进行了抗肺动脉高压治疗；然而，患者无反应,入院后26日死亡.尸检显示肺动脉有多个微小的肿瘤栓子。在没有栓塞的肺动脉部分，观察到纤维细胞内膜增生和狭窄。肿瘤栓塞表达为CK7+/CK20-，与原发性乳腺癌一致。
结论：由于PTTM的原发性病理生理学需要由于纤维细胞内膜增生而不是多发性肿瘤血栓而缩小，讨论了化疗联合血管扩张剂的疗效。
方法：患者为一名50岁女性，因IIIA期（T3N2M0）三阴性左乳腺癌行乳房切除术和腋窝淋巴结清扫术。术后随访放疗和抗癌化疗。手术后17个月,患者因右心衰竭住院，并诊断为肺动脉高压。使用楔形抽吸细胞学检查在肺动脉中检测到恶性细胞后，患者被诊断为PTTM。进行了抗肺动脉高压治疗；然而，患者无反应,入院后26日死亡.尸检显示肺动脉有多个微小的肿瘤栓子。在没有栓塞的肺动脉部分，观察到纤维细胞内膜增生和狭窄。肿瘤栓塞表达为CK7+/CK20-，与原发性乳腺癌一致。
结论：由于PTTM的原发性病理生理学需要由于纤维细胞内膜增生而不是多发性肿瘤血栓而缩小，讨论了化疗联合血管扩张剂的疗效。
