Tumoral pulmonary hypertension

Area of Science:

• Cardiology
• Oncology
• Pulmonary Medicine

Background:

• Tumoral pulmonary hypertension (PH) encompasses diverse subtypes in patients with current or prior malignancy.
• Key conditions include pulmonary tumor microembolism, thrombotic microangiopathy, macroembolism, and vascular tumors.
• These are often found post-mortem and are challenging to diagnose ante-mortem.

Purpose of the Study:

• To elucidate the subtypes, pathophysiology, investigation, and management of tumoral PH.
• To highlight the importance of considering tumoral PH in unexplained cases, particularly with a malignancy history.

Main Methods:

• Review of existing literature on tumoral PH subtypes.
• Discussion of diagnostic challenges and emerging therapeutic strategies.
• Analysis of tumoral PH associated with malignancy treatments.

Main Results:

• Tumoral PH includes microvascular conditions (e.g., pulmonary tumor microembolism) and macrovascular involvement (e.g., angiosarcoma).
• Treatment-induced PH (e.g., from tyrosine kinase inhibitors, chemotherapy, radiotherapy) is an emerging concern.
• Poor response to standard treatments and a history of malignancy are key indicators.

Conclusions:

• Tumoral PH presents uniquely and requires specific diagnostic and management considerations.
• Emerging evidence suggests potential survival benefits from pulmonary vasodilators and anti-inflammatory treatments.
• Increased awareness and consideration of tumoral PH are vital for patients with unexplained PH and a history of malignancy.