■肺肿瘤血栓性微血管病(PTTM)是一种罕见的转移性癌并发症,发生在肺动脉高压患者身上,而且大部分是致命的.循环肿瘤细胞簇已被认为是乳腺癌进展过程中的关键因素。
一名患有三阴性乳腺癌的80岁女性因进行性呼吸困难和下背痛入院。乳腺癌治疗包括乳房切除术,新辅助和辅助化疗以及辅助放疗,在她死前8天接受最后一次放疗.入院时,D-二聚体强烈升高,血小板低。NT-pro-BNP中度升高。胸部CT扫描未显示肺栓塞,但显示小叶间隔增厚,小叶中心固结,肺动脉扩张.此外,描述了新的骨骼和最可能的淋巴转移。开始用氧气和口服糖皮质激素治疗,假设放疗引起的肺炎。由于PD-L1的低表达和她明显不良的表现状态,肿瘤特异性治疗是不可能的,治疗方案改为最佳支持治疗.患者入院8天后死亡。尸检显示许多事件与肺血管中的肿瘤栓子一致,提示PTTM。
■PTTM是恶性乳腺癌的一种罕见且致命的并发症。由于早期检测很困难,需要进一步调查。循环肿瘤簇细胞可能是早期检测PTTM和提高患者生存率的一种方法。
UNASSIGNED: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare complication of metastatic carcinoma, which occurs in patients with pulmonary arterial hypertension, and is mostly fatal. Circulating tumor cell clusters have been recognized as critical factors during breast cancer progression.
UNASSIGNED: An 80-year-old woman with triple-negative breast cancer was admitted to our hospital with progressive dyspnea and lower back pain. Breast cancer treatment included mastectomy, neoadjuvant and adjuvant chemotherapy as well as adjuvant radiotherapy, receiving her last cycle of radiotherapy 8 days before death. At admission, D-dimers were strongly elevated and platelets were low. NT-pro-BNP was moderately elevated. A CT scan of the chest did not show pulmonary embolism but revealed interlobular septal thickening, centrilobular consolidation, and distension of the pulmonary arteries. Moreover, new skeletal and most likely lymphatic metastasis was described. Treatment with oxygen and oral glucocorticoids was initiated, assuming radiotherapy-induced pneumonitis. Due to low expression of PD-L1 and her markedly bad performance status, tumor-specific therapy was not possible, and the treatment regimen was changed to best supportive care. The patient died 8 days after admission. Autopsy revealed numerous events consistent with tumor emboli in the pulmonary vessels, suggesting PTTM.
UNASSIGNED: PTTM is a rare and mostly fatal complication in malignant breast cancer. As an early detection is difficult, further investigation is needed. Circulating tumor cluster cells may be one way to detect PTTM early and improve patients\' survival.