Early Gastric Carcinoma with Widespread Metastasis and Pulmonary Tumor Thrombotic Microangiopathy (PTTM), Report of an Autopsy Case Seiji Igarashi 1,2 , Takanori Kawaguchi 2 , Nobuo Hoshi 2 1Department of Pathology, Tochigi Cancer Center 2The Second Department of Pathology, Fukushima Medical College Keyword: 早期胃癌 , 転移 , 肺腫瘍塞栓 , PTTM pp.861-865
Published Date 1997/5/25
DOI https://doi.org/10.11477/mf.1403105150
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 A twenty nine-year-old woman was admitted to the hospital for progressive respiratory distress. She died from pulmonary hypertension and right heart failure about 8 month from the onset. She was 18 weeks of pregnancy at the time of death. Autopsy revealed a 20×20 mm-sized early gastric carcinoma,(0 Ⅱc+Ⅱa m, sig, 1y1, v0, INFβ) which metastasized to lymph nodes in various areas, bone (lumbar and thoracic, examind), and both ovaries. Although neither parenchyma nor interstitium of both lungs was not involved by metastatic cells, there were multiple fresh infarctions in entire lobes of the both lungs resulting from tumor emboli mainly in the small pulmonary arteries with striking fibromuscular thickening of the intima. Morphology of the vascular changes was consistent with that of pulmonary tumor thrombotic microangiopathy (PTTM) and was considered to be the direct cause of the death of this patient. To evaluate factors affecting the pathogeneses involved in strong metastatic potential of the carcinoma and PTTM, we performed immunohistochemical studies on expressions of estrogen receptor (ER) and tissue factor (TF) using monoclonal antibodies but no positive signs for both antibodies were observed.

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