Rare cause of repeated pulmonary embolism: a case of primary pleural squamous cell carcinoma and literature review

Abstract

Background: Malignant tumors are risk factors for a pulmonary embolism (PE), and a PE caused by a tumor is not uncommon. Primary pleural squamous cell carcinoma (PPSCC) is a rare malignancy; thus, a related PE is extremely rare. Case presentation: A previously healthy 49-year-old female patient was admitted to Northern Jiangsu People's Hospital owing to chest tightness, cough, and breathing difficulty that persisted for 3 days. Following admission, a computed tomography (CT) pulmonary angiography revealed an embolism in the main pulmonary artery, upper and lower pulmonary artery branch. The patient was treated with alteplase, warfarin, and antibiotics. Over the following year, she experienced recurrent chest pain and tightness and breathing difficulty, with multiple CT pulmonary angiography revealing thrombosis in the right and left main pulmonary artery. No abnormalities were observed in surrogate markers of autoimmune diseases, tumor antigen testing, or ultrasonography; thus, the cause of recurrent PE was not identified. Subsequently, a positron emission tomography-computed tomography (PET-CT) examination revealed diffuse heterogeneous thickening of the right pleura and substantially increased glucose metabolism. A CT-guided pleural biopsy was performed, and histopathological examination of the pleura eventually revealed a diagnosis of PPSCC. Conclusions: PPSCC is a rare tumor that lacks specific clinical manifestations and is difficult to detect with imaging techniques. The occurrence of PE as the primary manifesting symptom in a patient with PPSCC is extremely rare. Thus, malignant tumors should be considered in patients with no risk factors for PE and/or in those with recurrent PE. An immediate diagnosis and adequate intervention can be achieved with increased awareness of this diagnosis and subsequent related examinations.

Clinical characteristics and risk factors predictive of pulmonary embolism complicated in bronchiectasis patients: a retrospective study

“…Thus, although the prevalence of peripheral and coronary vascular diseases is very high in both PE patients and controls, it is likely not the main reason for the elevated levels of homocysteine. Furthermore, pulmonary embolism is one of the most common complications of active malignancy tumors [ 18 ]. However, our results of the univariate analysis show that the active malignancy tumor is not an independent risk factor for pulmonary embolism in bronchiectasis patients (p = 0.218).…”

Squamous cell carcinoma as a primary pleural tumor – case report

“…In 2017 Z Chen et al [4] described the case of a 49-year-old woman with primary squamous cell carcinoma of the pleura, in whom the results of IHC tests were positive for p63, protein 40 (p40), cytokeratin 5 (CK5), CK 6, EMA, and negative for calretinin. It should be noted that IHC results coincided with the results of the examinations of our patient.…”

Changes in lung mechanics and ventilation-perfusion match: comparison of pulmonary air- and thromboembolism in rats

“…This life-threatening condition can occur when air or other gases enter the pulmonary circulation, which commonly occurs following lung trauma, as a complication of childbirth, or during surgical interventions [ 2 ], scuba diving, or flying [ 3 ]. Another form of pulmonary embolism occurs when the pulmonary vessels are occluded by a solid blood clot or other bodily substance, such as following deep venous thrombi or in cancer-associated thrombosis [ 1 , 4 ].…”