title: Pulmonary tumor thrombotic microangiopathy diagnosed antemortem and treated with combination chemotherapy.
abstract: A 29-year-old man developed a persistent dry cough. Chest high-resolution computed tomography (HRCT) revealed centrilobular ultrafine granular shadows scattered in all lung fields. A lung biopsy with video-assisted thoracoscopic surgery revealed findings compatible with pulmonary tumor thrombotic microangiopathy (PTTM). However, the primary tumor was not identified. Combination chemotherapy with S-1 and cisplatin decreased his cough and improved the chest HRCT findings. The illness, however, gradually became difficult to control. He eventually developed pulmonary hypertension and died. Typically, an antemortem diagnosis of PTTM cannot be made. In this case, the diagnosis of PTTM and combination chemotherapy improved the chest HRCT findings, respiratory symptoms, and prognosis.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Okayama Medical Center, Japan. hk85hk64@yahoo.co.jp
authors.forename: Hiroe
authors.initials: H
authors.lastname: Kayatani
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ueda
authors.forename: Mizuho
authors.initials: M
authors.lastname: Matsushita
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiwara
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yonei
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yamadori
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Shigematsu
authors.forename: Akio
authors.initials: A
authors.lastname: Andou
authors.forename: Toshio
authors.initials: T
authors.lastname: Sato
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D001706:Biopsy; D018279:Carcinoma, Signet Ring Cell / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002945:Cisplatin / Q000008:administration & dosage; D004338:Drug Combinations; D017809:Fatal Outcome; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D008175:Lung Neoplasms / Q000098:blood supply / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D009382:Neoplasms, Unknown Primary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D010094:Oxonic Acid / Q000008:administration & dosage; D011651:Pulmonary Artery / Q000473:pathology; D005641:Tegafur / Q000008:administration & dosage; D020775:Thoracic Surgery, Video-Assisted; D057049:Thrombotic Microangiopathies / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D002945:Cisplatin