Occult Gastric Cancer Presenting as Hypoxia from Pulmonary Tumor Thrombotic Microangiopathy.
10.5230/jgc.2014.14.2.142
- Author:
Rohan MANDALIYA
1
;
Salman FARHAT
;
Dipesh UPRETY
;
Mamtha BALLA
;
Apurva GANDHI
;
Richard GOLDHAHN
;
Herbert AUERBACH
;
Chris CHRISTENSEN
;
Conrad REED
;
Sidney COHEN
Author Information
1. Department of Medicine, Abington Memorial Hospital, Abington, PA, USA. rohan86m@gmail.com
- Publication Type:Case Report
- Keywords:
Stomach neoplasms;
Pulmonary tumor thrombotic microangiopathy;
Hypertension, pulmonary
- MeSH:
Adrenal Cortex Hormones;
Anoxia*;
Ants;
Autopsy;
Cadherins;
Diagnosis;
Echocardiography;
Heart Arrest;
Humans;
Hypertension, Pulmonary;
Intubation;
Nuclear Family;
Oxygen;
Stomach Neoplasms*;
Thrombotic Microangiopathies*;
Ventilators, Mechanical
- From:Journal of Gastric Cancer
2014;14(2):142-146
- CountryRepublic of Korea
- Language:English
-
Abstract:
Pulmonary tumor thrombotic microangiopathy (PTTM) causing fatal pulmonary hypertension is a rare presentation of malignancy. In general, patients with PTTM rapidly succumb to death due to severe hypoxia. To date, very few cases of PTTM have been reported in the literature; and most of these cases were from gastric cancer and were diagnosed on post mortem autopsy, as it is extremely challenging to make an ante mortem diagnosis. We here report on a case of undiagnosed diffuse gastric cancer, presenting as worsening hypoxia. The clinical, radiographic, and echocardiographic features, and laboratory and pathological results were consistent with PTTM from gastric cancer. The patient was started on anticoagulation therapy, corticosteroids, and high-flow oxygen. However, her hypoxia worsened to the extent that she required ventilator support, and she died soon after intubation due to cardiac arrest. Since diffuse gastric cancer is associated with hereditary diffuse gastric cancer syndrome, cadherin 1 gene mutation analysis was performed to estimate the risk to her daughters. The test came back negative.
