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肺肿瘤血栓性微血管病1例并文献复习
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Abstract:
目的：提高临床医生对肺肿瘤血栓性微血管病(PTTM)的早期的识别和诊断。方法：报道我科的1例临床诊断PTTM病例，对截止到2022年9月国内外文献报道的中国PTTM病例进行回顾性分析。结果：连同本例在内共20篇27例国内的PTTM病例报道。原发肿瘤中，最多的是胃癌(51.9%)，最常见的临床症状为渐进性加重的呼吸困难(88.9%)，90%的病例肺动脉CTA未见肺栓塞，心脏彩色超声提示中位肺动脉压为66.6 (64.71) mmHg。结论：PTTM是一种极少见的肿瘤相关并发症，预后极差，主要表现为进行性呼吸困难及干咳，绝大多数伴有肺动脉高压，CTPA为阴性，确诊依靠病理，但因疾病进展快，多无法耐受有创检查导致确诊困难。生前早期诊断及治疗是改善预后的关键。
Objective: To improve the early identification and diagnosis of lung tumor thrombotic microangi-opathy (PTTM) by clinicians. Methods: Reported a clinical diagnosis of PTTM case in our department, and conducted a retrospective analysis of Chinese PTTM cases reported in domestic and foreign lit-erature up to September 2022. Results: Together with this case, 20 cases were reported on 27 do-mestic PTTM cases. Among the primary tumors, the most frequent was gastric cancer (51.9%), the most common clinical symptoms were progressive dyspnea (88.9%), pulmonary CTA in 90% of cases without pulmonary embolism, and cardiac color ultrasound suggested a median pulmonary artery pressure of 66.6 (64.71) mmHg. Conclusion: PTTM is a rare tumor-related complication with a very poor prognosis, mainly manifested as progressive dyspnea and dry cough, the vast majority of which are accompanied by pulmonary hypertension, negative CTPA, relying on pathology, but due to the rapid progress of the disease, it is difficult to tolerate invasive examination. Early diagno-sis and treatment in life is the key to improving the prognosis.
| [1] | Uruga, H., Fujii, T., Kurosaki, A., et al. (2013) Pulmonary Tumor Thrombotic Microangiopathy: A Clinical Analysis of 30 Autopsy Cases. Internal Medicine, 52, 1317-1323. https://doi.org/10.2169/internalmedicine.52.9472 |
| [2] | Patrignani, A., Purcaro, A., Calcagnoli, F., Mandolesi, A., Bearzi, I. and Ciampani, N. (2014) Pulmonary Tumor Thrombotic Microangiopathy: The Challenge of the Antemortem Diagnosis. Journal of Cardiovascular Medicine, 15, 828-833. https://doi.org/10.2459/JCM.0b013e328354e473 |
| [3] | 占丰富, 张孝斌, 黄茂宏, 等. 肺肿瘤血栓性微血管病2例报道并文献复习[J]. 疑难病杂志, 2022, 21(7): 736-741.
https://doi.org/10.3969/j.issn.1671-6450.2022.07.013 |
| [4] | Ma, G., Wang, D., Xu, X., Liang, L. and Xu, L. (2022) Case Report: Apatinib plus Selexipag as a Novel Therapy for Pulmonary Tumor Thrombotic Microangiopathy Accompa-nied by Pulmonary Hypertension Associated with Gastric Carcinoma. Medicine (Baltimore), 101, e29412. https://doi.org/10.1097/MD.0000000000029412 |
| [5] | Cui, N., Wang, L. and Zhao, J. (2020) Pulmonary Tumour Thrombotic Microangiopathy Presented as Gastric Signet Ring Cell Carcinoma: A Case Report. Journal of International Medical Research, 48.
https://doi.org/10.1177/0300060520910884 |
| [6] | To, H.H.M., Mak, W.W.L., Chan, T.H., et al. (2021) A Case of Pulmonary Tumoral Thrombotic Microangiopathy Supported by VA-ECMO and a Review of the Literature. Journal of Cardiology Cases, 24, 114-117.
https://doi.org/10.1016/j.jccase.2021.02.009 |
| [7] | Chen, C.K. (2018) Pulmonary Tumor Thrombotic Microangiopa-thy: Case Report and Literature Review. Journal of Acute Medicine, 8, 127-131. |
| [8] | Lu, L., Wang, Z., Li, H., et al. (2021) Bevacizumab Combined with Pemetrexed Successfully Treated Lung Adenocarcinoma Complicated with Pulmo-nary Tumor Thrombotic Microangiopathy: A Case Report and Literature Review. Annals of Palliative Medicine, 10, 767-777. https://doi.org/10.21037/apm-20-2220 |
| [9] | Shen, L., Yang, L., Jiang, H., Mo, T. and Fan, M. (2021) Pulmonary Tumor Thrombotic Microangiopathy of Patient with both Hepatocellular Carcinoma and Gastric Signet-Ring Cell Carcinoma: A Case Report and Review of Literature. Translational Cancer Research, 10, 1930-1940. https://doi.org/10.21037/tcr-20-3107 |
| [10] | 曾庆萃, 龙怀聪, 王玉霞. 临床诊断肺肿瘤血栓栓塞性微血管病一例并文献复习[J]. 中国呼吸与危重监护杂志, 2018, 17(3): 279-284. |
| [11] | 黎君曦, 郭文亮 ,雷永霞, 等. 乳腺癌并发肺肿瘤血栓性微血管病一例并文献复习[J]. 国际呼吸杂志, 2021, 41(23): 1819-1825. |
| [12] | 马苗, 苗立云, 丁晶晶, 等. 肺肿瘤血栓性微血管病五例并文献复习[J]. 海南医学, 2018, 29(15): 2205-2208.
https://doi.org/10.3969/j.issn.1003-6350.2018.15.041 |
| [13] | 孙文凯, 商庆发, 徐梓童, 等. 隐匿性胃腺癌致肺肿瘤血栓性微血管病猝死1例[J]. 法医学杂志, 2020, 36(4): 579-581. https://doi.org/10.12116/j.issn.1004-5619.2020.04.029 |
| [14] | 王杰, 黄华萍, 李羲, 等. 肺肿瘤血栓性微血管病临床诊断一例并文献复习[J]. 中华肺部疾病杂志(电子版), 2018, 11(4): 504-506. |
| [15] | 王军, 陈建武, 邱乾德, 等. 肺肿瘤血栓性微血管病CT表现一例[J]. 中华放射学杂志, 2018, 52(9): 719-720. |
| [16] | 酆孟洁, 邱晨, 冼志鸿. 肺肿瘤血栓性微血管病1例并文献复习[J]. 疑难病杂志, 2018, 17(3): 293-299.
https://doi.org/10.3969/j.issn.1671-6450.2018.03.019 |
| [17] | 张灿堂, 李元芹, 张淼, 等. 临床诊断为肺肿瘤血栓性微血管病一例并文献复习[J]. 实用心脑肺血管病杂志, 2020, 28(4): 114-120. https://doi.org/10.3969/j.issn.1008-5971.2020.04.023 |
| [18] | 张娟娟, 桂贤华, 蔡后荣, 等. 三例肺肿瘤血栓性微血管病的临床、影像及病理分析[J]. 中国呼吸与危重监护杂志, 2018, 17(5): 509-513. |
| [19] | 周玲玲, 夏国际. 肺腺癌合并血栓性微血管病1例[J]. 南昌大学学报(医学版), 2019, 59(4): 100-102.
https://doi.org/10.13764/j.cnki.ncdm.2019.04.023 |
| [20] | 刘瑶琦, 巩海红, 程兆忠. 直肠癌、阴囊Paget病并肺肿瘤血栓性微血管病一例[J/CD]. 中国临床案例成果数据库, 2022, 4(1): E00959. |
| [21] | 代诗琼, 李斌, 邱国院. 1例胃腺癌致肺肿瘤血栓性微血管病诊治学习[J]. 健康必读, 2021(28): 279. |
| [22] | von Herbay, A., Illes, A., Waldherr, R. and Otto, H.F. (1990) Pulmonary Tumor Thrombotic Microangiopathy with Pulmonary Hypertension. Cancer, 66, 587-592.
https://doi.org/10.1002/1097-0142(19900801)66:3<587::AID-CNCR2820660330>3.0.CO;2-J |
| [23] | Miyano, S., Izumi, S., Takeda, Y., et al. (2007) Pulmonary Tumor Thrombotic Microangiopathy. Journal of Clinical Oncology, 25, 597-599. https://doi.org/10.1200/JCO.2006.09.0670 |
| [24] | Buser, M., Felizeter-Kessler, M., Lenggenhager, D. and Maeder, M.T. (2015) Rapidly Progressive Pulmonary Hypertension in a Patient with Pulmonary Tumor Thrombotic Mi-croangiopathy. American Journal of Respiratory and Critical Care Medicine, 191, 711-712. https://doi.org/10.1164/rccm.201501-0004IM |
| [25] | Kitazono, T., Tsubouchi, K., Ibusuki, R., et al. (2021) A Rare Case of Pulmonary Tumor Thrombotic Microangiopathy Associated with Micropapillary Urothelial Carcinoma of the Urinary Bladder: An Autopsy Case. Internal Medicine, 60, 2843-2846. https://doi.org/10.2169/internalmedicine.6553-20 |
| [26] | Wakabayashi, Y., Iwaya, M., Akita, M., et al. (2016) Pul-monary Tumor Thrombotic Microangiopathy Caused by Urothelial Carcinoma Expressing Vascular Endothelial Growth Factor, Platelet-derived Growth Factor, and Osteopontin. Internal Medicine, 55, 651-656. https://doi.org/10.2169/internalmedicine.55.5758 |
| [27] | Burciaga Calderoni, C., Moretta, D.T., Merrill-Henry, J. and Giri, P.C. (2020) Pulmonary Tumor Thrombotic Microangiopathy Presenting as Recurrent Syncope. SAGE Open Medi-cal Case Reports, 8.
https://doi.org/10.1177/2050313X20969044 |
| [28] | Rajdev, K., Madan, U., McMillan, S., et al. (2022) Pulmonary Tumor Embolism and Pulmonary Tumor Thrombotic Microangiopathy Causing Rapidly Progressive Respiratory Failure: A Case Series. Journal of Investigative Medicine High Impact Case Reports, 10. https://doi.org/10.1177/23247096221086453 |
| [29] | Katayama, D., Kuriyama, K., Kinoshita, T., et al. (2016) Pulmo-nary Tumor Thrombotic Microangiopathy Caused by Prostate Carcinoma. Acta Radiologica Open, 5. https://doi.org/10.1177/2058460116662300 |
| [30] | Shimizu, N., Ito, T., Sato, S., Sugiura, Y. and Tatsuno, I. (2022) Urothelial Carcinoma with Pulmonary Tumor Thrombotic Microangiopathy after Chemotherapy for Hodgkin Lymphoma. Journal of Clinical Medicine Research, 14, 327-333.
https://doi.org/10.14740/jocmr4802 |
| [31] | Toyonaga, H., Tsuchiya, M., Sakaguchi, C., et al. (2017) Pulmonary Tu-mor Thrombotic Microangiopathy Caused by a Parotid Tumor: Early Antemortem Diagnosis and Long-term Survival. Internal Medicine, 56, 67-71.
https://doi.org/10.2169/internalmedicine.56.7439 |
| [32] | Raimondi, F., Conti, C., Novelli, L., et al. (2021) A 57-Year-Old Man with Rapidly Progressive Pulmonary Hypertension. Monaldi Archives for Chest Disease, 92, Article 1930. https://doi.org/10.4081/monaldi.2021.1930 |
| [33] | Price, L.C., Wells, A.U. and Wort, S.J. (2016) Pulmonary Tumour Thrombotic Microangiopathy. Current Opinion in Pulmonary Medicine, 22, 421-428. https://doi.org/10.1097/MCP.0000000000000297 |
