A Case of Pulmonary Tumor Thrombotic Microangiopathy Diagnosed by Transbronchial Lung Biopsy and Treated with Chemotherapy and Long-Term Oxygen and Anticoagulation Therapies
A 41-year-old woman, who underwent breast resection for cancer of the right breast and adjuvant chemotherapy 2 years ago, was admitted to our hospital due to shortness of breath upon exertion. High-resolution computed tomography of the chest showed small nodular opacities in the peribronchiolar area in both lungs, as well as mediastinal and hilar lymphadenopathy. A transbronchial lung biopsy revealed breast cancer metastasis and pulmonary tumor thrombotic microangiopathy (PTTM). Treatment of PTTM is rarely reported due to the difficulty of antemortem diagnosis; however, the patient was effectively treated with chemotherapy and oxygen and anticoagulation therapies for 3 months. 1. Introduction Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare complication of malignant diseases that was first reported by von Herbay et al. in 1990 [1]. An antemortem diagnosis of PTTM is difficult, due to the typical development of acute pulmonary hypertension, which causes heart failure, shortness of breath, and death in a few days [2]. PTTM was diagnosed in the present case by a transbronchial lung biopsy (TBLB), despite severe pulmonary hypertension. The patient was effectively treated with chemotherapy and oxygen and anticoagulation therapies. 2. Case Report A 41-year-old Japanese woman, with no history of cigarette smoking or familial cancer, was diagnosed in our hospital 2 years ago with clinical stage 2B (T2N1M0, according to the TNM classification (7th edition) of the International Union Against Cancer) invasive micropapillary carcinoma of the right breast. The immunostaining data for the estrogen receptor (ER), progesterone receptor (PR), and CerbB-2 (HER2) is negative in neoplastic cells. The patient underwent 4 courses of definitive neoadjuvant chemotherapy with cyclophosphamide, epirubicin, and fluorouracil (500？mg/m2, 100？mg/m2, and 500？mg/m2 on day 1, resp.) every 3 weeks and 2 courses of additional chemotherapy with docetaxel (75？mg/m2 on day 1) every 3 weeks. Despite chemotherapy treatment, the right breast mass increased in size. Resection of the right breast was performed, and a pathological diagnosis of stage 3B (T3N2M0) breast cancer was made. Following resection, the patient underwent definitive adjuvant chemoradiotherapy with capecitabine (300？mg/body) for 6 months, with concurrent radiation of 50？Gy in 25 fractions. A complete response, confirmed by computed tomography (CT) scanning, was achieved, and the patient was subsequently seen on a regular basis for followup. One year after definitive treatment, the patient was readmitted to our
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