title: Occult gastric cancer presenting as hypoxia from pulmonary tumor thrombotic microangiopathy.
abstract: Pulmonary tumor thrombotic microangiopathy (PTTM) causing fatal pulmonary hypertension is a rare presentation of malignancy. In general, patients with PTTM rapidly succumb to death due to severe hypoxia. To date, very few cases of PTTM have been reported in the literature; and most of these cases were from gastric cancer and were diagnosed on post mortem autopsy, as it is extremely challenging to make an ante mortem diagnosis. We here report on a case of undiagnosed diffuse gastric cancer, presenting as worsening hypoxia. The clinical, radiographic, and echocardiographic features, and laboratory and pathological results were consistent with PTTM from gastric cancer. The patient was started on anticoagulation therapy, corticosteroids, and high-flow oxygen. However, her hypoxia worsened to the extent that she required ventilator support, and she died soon after intubation due to cardiac arrest. Since diffuse gastric cancer is associated with hereditary diffuse gastric cancer syndrome, cadherin 1 gene mutation analysis was performed to estimate the risk to her daughters. The test came back negative.
authors: Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
authors: Rohan
authors: R
authors: Mandaliya
authors: Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
authors: Salman
authors: S
authors: Farhat
authors: Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
authors: Dipesh
authors: D
authors: Uprety
authors: Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
authors: Mamtha
authors: M
authors: Balla
authors: Department of Medicine, Abington Memorial Hospital, Abington, PA, USA.
authors: Apurva
authors: A
authors: Gandhi
authors: Department of Anatomy and Pathology, Abington Memorial Hospital, Abington, PA, USA.
authors: Richard
authors: R
authors: Goldhahn
authors: Department of Anatomy and Pathology, Abington Memorial Hospital, Abington, PA, USA.
authors: Herbert
authors: H
authors: Auerbach
authors: Division of Pulmonary and Critical Care, Abington Memorial Hospital, Abington, PA, USA.
authors: Chris
authors: C
authors: Christensen
authors: Division of Pulmonary and Critical Care, Abington Memorial Hospital, Abington, PA, USA.
authors: Conrad
authors: C
authors: Reed
authors: Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors: Sidney
authors: S
authors: Cohen
keywords: Hypertension, pulmonary; Pulmonary tumor thrombotic microangiopathy; Stomach neoplasms