Pulmonary Tumor Thrombotic Microangiopathy

Abstract

The authors indicated no potential conflicts of interest. REFERENCES 1. Bordignon KC, Neto MC, Ramina R, et al: Patterns of neuroaxis dissemination of gliomas: Suggestion of a classification based on magnetic resonance imaging findings. Surg Neurol 65:472-477, 2006; discussion 65:477, 2006 2. Engelhard HH, Corsten LA: Leptomeningeal metastasis of primary central nervous system (CNS) neoplasms. Cancer Treat Res 125:71-85, 2005 3. Gururangan S, McLaughlin CA, Brashears J, et al: Incidence and patterns of neuraxis metastases in children with diffuse pontine glioma. J Neurooncol 77:207-212, 2006 4. Stupp R, Mason WP, van den Bent MJ, et al: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987-996, 2005 5. Wen PY, Kesari S, Drappatz J: Malignant gliomas: Strategies to increase the effectiveness of targeted molecular treatment. Expert Rev Anticancer Ther 6:733-754, 2006 6. Jackman DM, Holmes AJ, Lindeman N, et al: Response and resistance in a non-small-cell lung cancer patient with an epidermal growth factor receptor mutation and leptomeningeal metastases treated with high-dose gefitinib.

Pulmonary tumour thrombotic microangiopathy

“…Cough may predate dyspnoea. Haemoptysis, chest and abdominal pain, which may reflect liver metastases or venous congestion, have also been reported [26]. The progression of symptoms correlates with HRCT findings prior to the onset of pulmonary hypertension, which may be a few weeks to months later [28].…”

“…Reports suggest that early use is effective in that it may resolve cough and centrilobular nodules on HRCT [28]. A combination approach for example with dexamethasone, warfarin and aspirin [26] may be more beneficial, with therapeutic response seen with falling D-dimer, serum VEGF and tumour markers [28,34,40]. Efficacy is likely to depend on chemosensitivity [41].…”

“…The sample should be heparinized, centrifuged and the buffy coat examined for malignant cells. Lung biopsy has been used to diagnose PTTM ante-mortem, either guided by CT, bronchoscopically or using video-assisted thoracoscopic surgery (VATS) [26,28,34]. However, we would advise caution in the presence of pulmonary hypertension.…”

“…Usually DIC is rapid and associated with bleeding, whereas in malignancy, 'compensated DIC' can occur, wherein the rate of consumption of coagulation factors and platelets is slow; thrombotic manifestations exceed bleeding events [24]. Evidence for raised D dimer or FDPs has been a uniform finding in PTTM [8,24], with features of microangiopathic haemolytic anaemia (MAHA) or DIC in half of cases at presentation [8,[24][25][26].…”

“…The use of dexamethasone (0.05 mg/kg daily, in combination with anticoagulation and chemotherapy) resulted in permanent resolution in one case of gastric cancer-associated PTTM [26], and to very short-term improvement in HRCT changes, cough, hypoxia and haemodynamics in a patient with recurrent breast carcinomaassociated PTTM [17 & ].…”