title: Signet-ring cell carcinoma of the gallbladder complicated by pulmonary tumor thrombotic microangiopathy.
abstract: Biliary drainage was performed in a 71-year-old man with obstructive jaundice of unknown origin; however, he died due to acute pulmonary failure. At autopsy, proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC) to the subserosa and bile ducts without growth toward the gallbladder lumen. Furthermore, fibrocellular intimal proliferation, tumor emboli and organized thrombi were observed in the small pulmonary arteries. The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM). PTTM may present as rapidly progressive dyspnea, and a high level of clinical suspicion is required to make the differential diagnosis.
authors.affiliation: Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ohno
authors.forename: Teru
authors.initials: T
authors.lastname: Kumagi
authors.forename: Taira
authors.initials: T
authors.lastname: Kuroda
authors.forename: Mitsuhito
authors.initials: M
authors.lastname: Koizumi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Azemoto
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamanishi
authors.forename: Mayu
authors.initials: M
authors.lastname: Oda
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirooka
authors.forename: Masanori
authors.initials: M
authors.lastname: Abe
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Ikeda
authors.forename: Bunzo
authors.initials: B
authors.lastname: Matsuura
authors.forename: Morikazu
authors.initials: M
authors.lastname: Onji
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Soga
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Mizuno
authors.forename: Atsurou
authors.initials: A
authors.lastname: Sugita
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hiasa
mesh_terms: D000368:Aged; D001344:Autopsy; D001652:Bile Ducts / Q000473:pathology; D018279:Carcinoma, Signet Ring Cell / Q000150:complications*; D005706:Gallbladder Neoplasms / Q000473:pathology; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications; D008168:Lung / Q000473:pathology; D008297:Male; D009360:Neoplastic Cells, Circulating; D011651:Pulmonary Artery / Q000473:pathology*; D013274:Stomach Neoplasms / Q000150:complications*; D057049:Thrombotic Microangiopathies / Q000209:etiology*