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[Tumor cell embolism to pulmonary arteries]
1Medizinische Klinik und, Institut für Pathologie der Charité, Berlin, Germany. w.scheppach@medizin.uni-wuerzburg.de
Zeitschrift Fur Gastroenterologie
|September 15, 2001
Summary
Tumor cell emboli from liver metastases can cause fatal pulmonary hypertension and acute cor pulmonale. This condition should be considered in patients with known or suspected malignancy presenting with pulmonary issues.
Area of Science:
- Oncology
- Cardiopulmonary Medicine
- Pathology
Background:
- Fulminant lung embolism and pulmonary hypertension can be life-threatening conditions.
- Metastatic disease, particularly from gastrointestinal or urothelial cancers, can spread to the liver.
- The clinical presentation of tumor cell emboli is often overlooked in differential diagnoses.
Observation:
- Two cases are presented: a 69-year-old male with urothelial carcinoma and liver metastases, and a 23-year-old female with gastric adenocarcinoma and liver metastases.
- Both patients experienced fatal pulmonary complications attributed to tumor cell emboli in pulmonary vessels.
- Autopsies revealed extensive tumor cell infiltration of small pulmonary arteries and arterioles.
Findings:
- Shedding of tumor cells from hepatic metastases can lead to obstruction of pulmonary vasculature.
- This obstruction results in acute cor pulmonale (right heart failure) and pulmonary hypertension.
- Tumor emboli were the cause of death in both cases, despite therapeutic interventions.
Implications:
- Tumor cell emboli should be a critical consideration in the differential diagnosis of acute pulmonary hypertension, especially in cancer patients.
- These findings highlight a potential mechanism for paraneoplastic pulmonary vascular disease.
- Early recognition of tumor emboli may improve patient outcomes and guide treatment strategies in oncology and critical care.