Published online Dec 28, 2019. doi: 10.3748/wjg.v25.i48.6949
Peer-review started: October 8, 2019
First decision: November 27, 2019
Revised: December 6, 2019
Accepted: December 21, 2019
Article in press: December 22, 2019
Published online: December 28, 2019
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare condition in patients with hepatocellular carcinoma (HCC); to date, few cases have been reported. While hepatic dysfunction has been focused on the later stages of HCC, the management of symptoms in PTTM is important for supportive care of the cases. For the better understanding of PTTM in HCC, the information of our recent case and reported cases have been summarized.
A patient with HCC exhibited acute and severe respiratory failure. Radiography and computed tomography of the chest revealed the multiple metastatic tumors and a frosted glass–like shadow with no evidence of infectious pneumonia. We diagnosed his condition as acute respiratory distress syndrome caused by the lung metastases and involvement of the pulmonary vessels by tumor thrombus. Administration of prednisolone to alleviate the diffuse alveolar damages including edematous changes of alveolar wall caused by the tumor cell infiltration and ischemia showed mild improvement in his symptoms and imaging findings. An autopsy showed the typical pattern of PTTM in the lung with multiple metastases.
PTTM is caused by tumor thrombi in the arteries and thickening of the pulmonary arterial endothelium leading to the symptoms of dyspnea in terminal staged patients. Therefore, supportive management of symptoms is necessary in the cases with PTTM and hence we believe that the information presented here is of great significance for the diagnosis and management of symptoms of PTTM with HCC.
Core tip: Pulmonary tumor thrombotic microangiopathy is caused by tumor thrombi in the arteries and thickening of the pulmonary arterial endothelium leading to the symptoms of dyspnea in terminal staged patients. Therefore, supportive management of symptoms is necessary in the cases with pulmonary tumor thrombotic microangiopathy, however, as the hepatic failure, bleeding, and encephalopathy have been focused in these cases with hepatocellular carcinoma and it is rare condition in the cases with hepatocellular carcinoma, only few cases have been reported. Therefore, we have reported the minute clinical and pathological information of our recent case and reviewed literatures of reported cases to date in this paper.