Lung Cancer With Tumor Emboli

Abstract

We report a case of squamous cell lung carcinoma that invaded the left atrium through the left pulmonary vein. This patient had two episodes of systemic embolism before diagnosis. The second episode was treated with embolectomy, and the pathology analysis showed squamous cell carcinoma. The tumor was surgically resected, using cardiopulmonary bypass to resect the intracardiac portion. We discuss causes of tumor emboli in lung cancer and surgical treatment.

Acute mesenteric ischemia leading to diagnosis of advanced spindle cell carcinoma of the lung

“…Nearly all reports of systemic arterial embolization in patients with any primary malignancy have discussed the mechanism by which pulmonary metastases, pulmonary primary tumors, or cardiac malignancies invade the pulmonary veins (PVs), fragment within the left atrium or within the PVs and subsequently enter the systemic circulation. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Another recognized mechanism is when the heart or aorta has been directly invaded by the tumor owing to proximity, achieving direct access to the arterial circulatory system. 4 , 5 , 6 , 7 , 8 , 9 Finally, in patients with known invasive lung cancer undergoing surgery, it has been reported that surgical manipulation of the PVs can result in arterial embolization.…”

“… 4 , 5 , 6 , 7 , 8 , 9 Finally, in patients with known invasive lung cancer undergoing surgery, it has been reported that surgical manipulation of the PVs can result in arterial embolization. 7 , 8 , 9 …”

“… 3 , 7 In those with no known history of myxoma or malignancy, it appears that the primary diagnosis of pulmonary malignancy has been most common. 1 , 3 , 5 , 7 , 8 Anatomically, this makes sense in terms of the mechanism of PV invasion.…”

“… 3 , 5 , 8 Cases of primary adenocarcinoma, epithelioid carcinoma, small cell carcinoma, bronchogenic carcinoma, and metastatic sarcoma have all been reported. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Spindle cell carcinoma is a rare subclassification of sarcomatoid carcinoma. 10 Moreover, sarcomatoid carcinoma only accounts for ∼0.1% to 0.4% of all non–small-cell lung cancer cases.…”

“…In the studies that had reported peripheral arterial embolism from malignancy, the most common sites of embolization were the aortic bifurcation, lower limbs, or cerebral vasculature. 2 , 4 , 5 , 6 , 7 , 8 , 9 Our review identified only five other cases of primary lung cancer embolizing to the SMA. 11 , 12 , 13 , 14 , 15 However, of these cases, the present case was the only case in which the acute ischemic event had preceded the diagnosis of lung cancer.…”