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Unusual presentation of pulmonary tumor thrombotic microangiopathy with no detectable primary tumor

N Seppala1, A Cala, S Klebe

  • 1Department of Anatomical Pathology, Flinders Medical Centre, Bedford Park, SA 5042, Australia.

Journal of Postgraduate Medicine
|February 27, 2009
PubMed

Insights

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition often diagnosed post-mortem. This case highlights ante-mortem diagnosis via bronchial biopsy in a patient with unexplained dyspnea.

Area of Science:

  • Pulmonary Pathology
  • Oncology
  • Nephrology

Background:

  • Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare vascular disorder.
  • It involves diffuse thrombotic microthrombi and intimal proliferation in pulmonary vasculature.
  • PTTM is linked to pulmonary tumor microemboli (PTM) and adenocarcinoma.

Observation:

  • PTTM mimics respiratory diseases like pulmonary embolism, hypertension, or pneumonia.
  • Diagnosis is typically made post-mortem.
  • This case involved an 82-year-old woman with atypical pneumonia symptoms.

Findings:

  • PTTM was identified ante-mortem using bronchial biopsy.
  • Autopsy confirmed PTTM originating from an unknown primary neoplasm.
  • The patient presented with unexplained dyspnea.

Implications:

  • Early diagnosis of PTTM is crucial for patient management.
  • Bronchial biopsy can aid in ante-mortem PTTM diagnosis.
  • Increased clinical suspicion is warranted in patients with adenocarcinoma and dyspnea.

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