title: Pulmonary tumor thrombotic microangiopathy from metastatic gallbladder carcinoma: an unusual cause of severe pulmonary hypertension.
abstract: Pulmonary hypertension and cor pulmonale due to tumor emboli causing pulmonary tumor thrombotic microangiopathy (PTTM) is rare and extremely difficult diagnosis to make prior to death. Pulmonary hypertension due to metastatic tumor emboli should be included in the differential diagnosis of various causes of dyspnea in patients with a history of cancer or more common causes, including infection, thromboembolism, metastasis, adverse effects of drugs, and recurrent effusions. We describe a patient with gallbladder carcinoma who presented with progressive dyspnea and severe pulmonary hypertension. The etiology was tumor emboli and PTTM from gallbladder carcinoma, which remained elusive prior to her death despite appropriate clinical investigations and was established on autopsy. To the best of our knowledge, this is likely the second reported case of PTTM from metastatic gallbladder carcinoma.
authors.affiliation: Department of Oncology, Heartland Regional Medical Center, St Joseph, MO 64503, USA. drmalani@yahoo.com
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Malani
authors.forename: Chakshu
authors.initials: C
authors.lastname: Gupta
authors.forename: Ahamed V P
authors.initials: AV
authors.lastname: Kutty
authors.forename: Thomas
authors.initials: T
authors.lastname: Betlej
mesh_terms: D018279:Carcinoma, Signet Ring Cell / Q000473:pathology*; D004417:Dyspnea / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology*; D008168:Lung / Q000098:blood supply* / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000556:secondary; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology* / Q000473:pathology; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology