title: Pulmonary tumour thrombotic microangiopathy as a cause of new-onset pulmonary hypertension in a patient with metastatic low-grade serous ovarian cancer.
abstract: A 78-year-old woman with metastatic low-grade serous ovarian cancer presented with rapidly progressive exertional dyspnoea and hypoxia, and was found to have new-onset severe pulmonary hypertension (PH) by right heart catheterisation. A diagnosis of pulmonary tumour thrombotic microangiopathy (PTTM) was made at autopsy. PTTM is a rare complication of advanced cancer that often presents as rapidly progressive PH or acute hypoxic respiratory failure. Widespread tumour cell emboli in the pulmonary arteries and arterioles are hypothesised to induce fibrocellular subintimal proliferation and microthrombi, leading to increased pulmonary vascular resistance and PH. PTTM arising from serous ovarian cancer is exceedingly rare, with only two previously reported cases. A discussion of the pathophysiology, diagnosis and management of PTTM is presented.
authors: Department of Internal Medicine, NYP/Weill Cornell Medical College, New York, New York, USA.
authors: Scott L
authors: SL
authors: Purga
authors: Department of Pathology, Weill Cornell Medical College, New York, New York, USA.
authors: Navneet
authors: N
authors: Narula
authors: Department of Cardiology, Weill Cornell Medical College, New York, New York, USA.
authors: Evelyn M
authors: EM
authors: Horn
authors: Department of Cardiology, Weill Cornell Medical College, New York, New York, USA.
authors: Maria G
authors: MG
authors: Karas
mesh_terms: D000368:Aged; D001344:Autopsy; D000077216:Carcinoma, Ovarian Epithelial; D018284:Cystadenocarcinoma, Serous / Q000556:secondary*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000188:drug therapy; D008175:Lung Neoplasms / Q000473:pathology*; D009375:Neoplasms, Glandular and Epithelial / Q000556:secondary*; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000556:secondary*; D011655:Pulmonary Embolism / Q000150:complications*; D013902:Radiography, Thoracic; D057049:Thrombotic Microangiopathies / Q000175:diagnosis*