Early diagnosis and bevacizumab combined with chemotherapy improved pulmonary tumor thrombotic microangiopathy with lung adenocarcinoma: A case report

Abstract

Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal cancer-related lung complication. PTTM is difficult to diagnose because of its nonspecific clinical manifestations and imaging findings. Furthermore, no effective treatments currently exist. This case report described a 57-year-old woman who was successfully diagnosed with PTTM and lung adenocarcinoma. She was admitted to our hospital for progressive dyspnea on exertion. Pulmonary artery catheterization revealed pulmonary hypertension (PH), and wedged pulmonary artery blood cell sampling disclosed histologically adenocarcinoma with TTF-1(+). We diagnosed the patient with PTTM associated with lung cancer. We started chemotherapy with paclitaxel, carboplatin, and bevacizumab. The treatment successfully improved PH, respiratory symptoms, and other outcomes. PTTM is a rare phenomenon, but it must be considered in the differential diagnosis of acute dyspnea or PH in patients with cancer. Our case report illustrates that aspiration cytology via right heart catheterization is useful for diagnosing PTTM. In addition, vascular endothelial growth factor inhibitors may be potentially effective for treating PTTM.

Keywords

• PTTM
• Pulmonary hypertension
• Aspiration cytology
• Antemortem diagnosis
• VEGF inhibitor