Massive tumor embolism in the abdominal aorta from pulmonary squamous cell carcinoma: Case report and review of the literature

Abstract

Acute arterial tumor embolism is a rare complication in cancer patients. Most of the previously reported cases of arterial tumor embolism have been associated with pulmonary malignancies and occurred during the intraoperative and postoperative periods. Very few cases occurred spontaneously. To our knowledge, there is no previous report of spontaneous and massive tumor embolism occluding the abdominal aorta in patients suffering from primary pulmonary carcinoma. We describe the case of 64-year-old man who presented with left homonymous hemianopsia and backache. Further evaluation revealed a mass in the right lung, severe coagulopathy, and cerebral hemorrhagic infarction in the right occipital lobe. He suddenly developed lower limb ischemia 4 weeks after his first clinical visit, and finally, died of multiple organ failure. Autopsy showed non-keratinizing squamous cell carcinoma in the right lung and massive tumor emboli in the abdominal aorta containing nests of squamous cell carcinoma. Infarct regions were found in the bilateral kidneys, spleen, liver, and brain; fibrin thrombi, but not tumor emboli, were found in these regions. This case suggested that tumor embolism should be considered when patients suffering from primary pulmonary malignancies develop arterial embolism and arterial tumor emboli could be massive enough to occlude the abdominal aorta.

Lung tumor presenting with acute myocardial infarction and lower extremity arterial embolism

“…The entry of lung tumors into left atrium via the pulmonary vein is uncommon [8]. Acute arterial embolism caused by tumor embolus is a rare complication in cancer patients.The accepted mechanism of arterial embolism in malignant lung tumors is that the tumor nests are expelled from the system after invading the pulmonary veins [2]. AMI caused by lung tumor embolus has been reported [5,9].…”

“…According to pre-existing reports, 4.5% of patients develop venous thromboembolism, and 1.5% of patients develop arterial thromboembolism; these conditions may result from the hypercoagulable state associated with cancers. Acute arterial embolismdue to tumor embolus is a rare complication in cancer patients [2], even rarer is lung tumor embolization leading to AMI. Lung tumor embolization was previously reported to occur in the coronary artery [3][4][5].…”

Tumor pulmonar acompañado de infarto agudo de miocardio y embolismo arterial en las extremidades inferiores

“…Según reportes previos, 4.5% de los pacientes desarrollan tromboembolismo venoso, y 1.5% de los pacientes desarrollan tromboembolismo arterial; estos padecimientos pueden ser resultado del estado hipercoagulable asociado con varios cánceres. El embolismo arterial agudo debido a un émbolo tumoral es una complicación poco frecuente en pacientes con cáncer [2], y aún más rara es que la embolización de un tumor cause IAM. Previamente se ha reportado la embolización de un tumor pulmonar en la arteria coronaria [3, 4, 5].…”

“…El embolismo arterial agudo causado por un émbolo tumoral es una complicación rara en pacientes con cáncer. El mecanismo aceptado del embolismo arterial en tumores de pulmón malignos involucra la expulsión de los nidos tumorales fuera del sistema luego de invadir las venas pulmonares [2]. Se han reportado casos de IAM causado por émbolos derivados de tumores pulmonares [5, 9].…”

An Autopsy Case of Pulmonary Tumor Emboli Due to Metastatic Squamous Cell Carcinoma

“…Shortness of breath among cancer patients can be due to several causes, such as infection, metastasis, thromboembolism, and other cardiopulmonary diseases [ 1 ]. Pulmonary tumor embolism syndrome (also known as pulmonary tumor embolic microangiopathy “PTEM”) is a rare cause of dyspnea in cancer population [ 2 ]. We present a case of pulmonary tumor embolism.…”