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Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

1175 - Pulmonary tumor thrombotic microangiopathy (PTTM): 24 case series and its criteria for pathological diagnosis.

Date

21 Oct 2018

Session

Poster display session: Basic science, Endocrine tumours, Gastrointestinal tumours - colorectal & non-colorectal, Head and neck cancer (excluding thyroid), Melanoma and other skin tumours, Neuroendocrine tumours, Thyroid cancer, Tumour biology & pathology

Presenters

Naoko Sato

Citation

Annals of Oncology (2018) 29 (suppl_8): viii670-viii682. 10.1093/annonc/mdy304

Authors

N. Sato1, T. Tasaki1, H. Noguchi1, K. Irie2, T. Nakayama1

Author affiliations

  • 1 Department Of Pathology, University of Occupational and Environmental Health, 807-8555 - Kitakyushu/JP
  • 2 Department Of Diagnostic Pathology, Kitakyushu General Hospital, 802-8517 - Kitakyushu/JP
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Resources

Abstract 1175

Background

PTTM is a fatal complication of malignancy causing progressive pulmonary hypertension (PH) or right heart failure. It is considered as a rare disease, but a growing number of cases have been reported. The pathogenesis is hypothesized that widespread cancer emboli in microscopic pulmonary arteries activate fibrocellular intimal proliferation and thrombosis. Adenocarcinomas, especially gastric ones, are the major cause. Pathological diagnosis of PTTM is apparently easy. However, microscopic pulmonary tumor emboli are a sporadic finding of cancer patients, which can resemble PTTM when followed by intimal changes and other pulmonary diseases. The increase of misdiagnosis is a concern as PTTM becomes better known. The purpose of this study is to build diagnostic criteria of PTTM.

Methods

24 cases diagnosed as PTTM in multiple institutions were collected and classified into two groups; (1) a definite group (n = 13), those who had been clinically diagnosed as PH, and (2) a suspicious group (n = 11), those who revealed respiratory symptoms but lacked clinical assessment of PH. As a control group, autopsy cases with PTTM-like lesions but who were lacking progressive respiratory symptoms were selected (n = 7). PTTM-like lesions in these groups was observed and counted.

Results

The numbers of PTTM-like lesions (fibrocellular intimal proliferation and thrombi with tumor cells) in the definite and non-PTTM group were 26.5-68.8 and 0.5-5.9/cm2 area of lung specimen. In definite cases, peripheral arterioles smaller than 150 μm in diameter were predominantly involved. In the suspicious group, 7 of 11 cases had as many lesions (25.4-68.9/cm2) in small arterioles as in the definite cases, while the remaining 4 had as few lesions (1.3-9.6/cm2) as the non-PTTM group. Lymphangitis carcinomatosa was seen in these 4 cases.

Conclusions

We suggest that the pathological criteria of PTTM is as follows: 1) fibrocellular intimal proliferation and thrombi with tumor cells 2) involvement of microscopic pulmonary arteries and arterioles, predominantly small ones in alveolar septa (<150 μm in diameter), and 3) the innumerable spreading of more than approximately 100 lesions/5 cm2 area of lung specimen.

Clinical trial identification

Legal entity responsible for the study

Naoko Sato.

Funding

A Grant-in-Aid for the Promotion of Occupational Health for the Post Graduate Student of the University of Occupational and Environmental Health.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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