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Pulmonary tumor thrombotic microangiopathy: Two case reports and literature review
Hua Ma1, Jian-Mei Gao2, Jing Wang1
1Clinical Medical College, Ningxia Medical University, Yinchuan, China.
Rationale:
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but serious complication in patients with malignancy; its main manifestation includes acute pulmonary hypertension with severe respiratory distress. More than 200 cases have been reported since it was first identified in 1990. PTTM accounts for approximately 0.9% to 3.3% of deaths due to malignancy, but only a minority of patients are diagnosed ante-mortem, with most patients having a definitive diagnosis after autopsy.
Patient Concerns:
Two middle-aged women both died within a short period of time due to progressive dyspnea and severe pulmonary hypertension.
Diagnoses:
One patient was definitively confirmed as a gastrointestinal malignant tumor by liver puncture biopsy pathology. Ultimately, the clinical diagnosis was pulmonary tumor thrombotic microangiopathy.
Interventions:
The patient was treated symptomatically with oxygen, diuresis, and anticoagulation, while a liver puncture was perfected to clarify the cause.
Outcomes:
Two cases of middle-aged female patients with rapidly progressive pulmonary hypertension and respiratory failure resulted in death with malignant neoplasm.
Lessons:
PTTM has a rapid onset and a high morbidity and mortality rate. Our clinicians need to be more aware of the need for timely diagnosis through a targeted clinical approach, leading to more targeted treatment and a better prognosis.
Insights
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare malignancy complication causing severe pulmonary hypertension and respiratory distress. Early diagnosis and targeted treatment are crucial for improving outcomes in this rapidly fatal condition.
Area of Science:
- Oncology
- Pulmonary Medicine
- Pathology
Background:
- Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but severe complication in cancer patients.
- It manifests as acute pulmonary hypertension and respiratory distress, contributing to 0.9%-3.3% of malignancy deaths.
- Diagnosis is often post-mortem, with few ante-mortem cases identified.
Purpose of the Study:
- To highlight the critical need for increased clinical awareness of PTTM.
- To emphasize the importance of timely and targeted diagnostic approaches.
- To underscore the potential for improved prognosis with earlier intervention.
Main Methods:
- Case study of two middle-aged women with fatal PTTM.
- Clinical presentation included progressive dyspnea and severe pulmonary hypertension.
- Diagnostic confirmation involved liver biopsy and autopsy findings.
Main Results:
- Both patients experienced rapid deterioration, succumbing to respiratory failure and pulmonary hypertension.
- One patient had a confirmed gastrointestinal malignancy.
- The clinical diagnosis of PTTM was established, though post-mortem confirmation was definitive.
Conclusions:
- PTTM is characterized by rapid onset and high mortality.
- Clinicians require heightened awareness for prompt diagnosis.
- A targeted clinical strategy is essential for effective treatment and better patient outcomes.
