title: Aortic intramural hematoma associated with metastatic carcinoma.
abstract: We present a case of aortic intramural hematoma, a variant of aortic dissection, with metastatic carcinoma invasion within the aortic wall and pseudolumen. An elderly male patient with a history of controlled hypertension initially experienced chest pain. A computed tomographic scan revealed aortic intramural hematoma; thus, conservative therapy was performed. One and a half months later, tumors in both adrenal glands and the lumbar vertebra were discovered. The primary site was not identified, and the patient died following septic shock 1 month later. An autopsy revealed intramural hematoma throughout the aorta, as well as systemic metastases of adrenocortical carcinoma with invasion into the aortic wall and formation of a pseudolumen accompanied by disruption of the vasa vasorum. As far as we know, this is the second case of aortic dissection associated with metastatic carcinoma. The highly aggressive nature of the tumor cells was demonstrated by high mitotic ratio and Ki-67 labeling index. The tumor was also positive for matrix metalloproteinase-12, thus suggesting disruption of the aortic media.
authors.affiliation: Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Rikuhei
authors.initials: R
authors.lastname: Tsuchida
authors.forename: Naoto
authors.initials: N
authors.lastname: Kasahara
authors.forename: Megumi
authors.initials: M
authors.lastname: Inobe
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Terado
authors.forename: Ayako
authors.initials: A
authors.lastname: Horita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yokoyama
authors.forename: Atsushiko
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Fujioka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kurata
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000473:pathology*; D018268:Adrenocortical Carcinoma / Q000175:diagnosis / Q000556:secondary*; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D001013:Aorta, Thoracic / Q000473:pathology; D001018:Aortic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D001019:Aortic Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D006406:Hematoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014651:Vasa Vasorum / Q000473:pathology; D019043:Vascular Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary*