Pulmonary tumor thrombotic microangiopathy caused by a gastric carcinoma expressing vascular endothelial growth factor and tissue factor
Pulmonary tumor thrombotic microangiopathy caused by a gastric carcinoma expressing vascular endothelial growth factor and tissue factor
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DOI：
10.1111/j.1440-1827.2005.01783.x
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发表时间：
2005-01-01
影响因子：
2.2
通讯作者：
Tsuchiya, E
中科院分区：
文献类型：
--
作者：
Chinen, K;Kazumoto, T;Tsuchiya, E
肺肿瘤血栓性微血管病(PTTM)是一种罕见的导致严重肺动脉高压的临床病理实体。其组织学特征包括广泛的肿瘤栓子，以及肺小动脉和小动脉的纤维细胞内膜增殖和血栓形成。其结果是肺血管闭塞或狭窄，尽管临床表现严重，但具体发病机制尚不清楚。本文报告一位62岁男性胃腺癌患者，因心肺骤停而死亡。尸检发现了晚期癌症以及PTTM的发现，这似乎是他意外死亡的原因。癌细胞的血管内皮生长因子(VEGF)和组织因子(TF)免疫组织化学染色均为阳性。另有报道认为，Tf可能在PTTM的发病机制中起重要作用。此外，据报道，血管内皮生长因子参与了多种形式的肺动脉高压，并被TF上调。提示血管内皮生长因子和组织因子可能参与了PTTM的发病过程。目前的PTTM病例中，肿瘤细胞显示出血管内皮生长因子和转铁蛋白的共同表达，这对未来了解这种致命性疾病很重要。
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare clinicopathological entity causing severe pulmonary hypertension. Its histological features include widespread tumor emboli along with fibrocellular intimal proliferation and thrombus formation in the small arteries and arterioles of the lungs. The result is occlusion or stenosis of the pulmonary vasculature, but the detailed pathogenesis has yet to be clarified in spite of the serious clinical manifestations. Herein is described the case of a 62-year-old man with a gastric adenocarcinoma who died of sudden cardiopulmonary arrest. The autopsy revealed advanced cancer disease as well as findings of PTTM, which seemed to be the cause of his unexpected death. The carcinoma cells were immunohistochemically positive for vascular endothelial growth factor (VEGF) and also for tissue factor (TF). There is another report suggesting that TF might play an important role in the pathogenesis of PTTM. Also, VEGF has been reported to be involved in a variety of forms of pulmonary hypertension and to be upregulated by TF. These findings suggest that VEGF and TF may be involved in the pathogenesis of PTTM. The present PTTM case, in which the tumor cells demonstrate the coexpression of VEGF and TF, is important in facilitating understanding of the lethal disorder in the future.