Pulmonary Tumor Thrombotic Microangiopathy Associated with Gastric Cancer: Clinical Characteristics and Outcomes

Aims Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal complication of gastric cancer (GC). We aimed to evaluate the clinical characteristics, outcomes, and immunohistochemical profiles of patients with GC-induced PTTM.

Methods From 2011 to 2023, eight patients were clinically diagnosed with PTTM associated with GC antemortem. The clinical features and outcomes were reviewed, and immunohistochemical staining for c-erbB-2, MutL protein homolog 1, and programmed cell death ligand-1 were performed.

Results The median patient age was 56 years (range: 34–66 years). In all patients, the tumors exhibited either an ulceroinfiltrative or diffusely infiltrative gross morphology. The median tumor size was 5.8 cm (range: 2.0 cm–15.0 cm). Poorly differentiated adenocarcinoma was the most common histologic type (6/8, 75%), followed by signet ring cell carcinoma (1/8, 12.5%) and moderately differentiated adenocarcinoma (1/8, 12.5%). Chest computed tomography revealed ground-glass opacities (7/8, 87.5%) or tree-in-bud signs (2/8, 25.0%) without definite evidence of pulmonary thromboembolism (PTE). Disseminated intravascular coagulation was present in 62.5% (5/8) of the patients diagnosed with PTTM. C-erbB-2 was positive in one patient (1/8, 12.5%). One patient who received palliative chemotherapy after developing PTTM survived for 35 days, whereas the other seven patients who did not receive chemotherapy after developing PTTM survived for 7 days or less after PTTM diagnosis.

Conclusions Most patients with GC-induced PTTM had an undifferentiated-type histology, infiltrative morphology, and extremely poor survival. Palliative chemotherapy may benefit patients with GC-induced PTTM, although further studies are needed to explore the potential of targeted therapy for these patients.

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Artikel online veröffentlicht:
27. März 2025