Journal of Gastric Cancer

  • 제14권2호
  • /
  • Pages.142-146
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  • 2014
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Occult Gastric Cancer Presenting as Hypoxia from Pulmonary Tumor Thrombotic Microangiopathy

  • Mandaliya, Rohan (Department of Medicine, Thomas Jefferson University Hospital) ;
  • Farhat, Salman (Department of Medicine, Thomas Jefferson University Hospital) ;
  • Uprety, Dipesh (Department of Medicine, Thomas Jefferson University Hospital) ;
  • Balla, Mamtha (Department of Medicine, Thomas Jefferson University Hospital) ;
  • Gandhi, Apurva (Department of Medicine, Thomas Jefferson University Hospital) ;
  • Goldhahn, Richard (Department of Anatomy and Pathology, Thomas Jefferson University Hospital) ;
  • Auerbach, Herbert (Department of Anatomy and Pathology, Thomas Jefferson University Hospital) ;
  • Christensen, Chris (Division of Pulmonary and Critical Care, Abington Memorial Hospital, Abington, Thomas Jefferson University Hospital) ;
  • Reed, Conrad (Division of Pulmonary and Critical Care, Abington Memorial Hospital, Abington, Thomas Jefferson University Hospital) ;
  • Cohen, Sidney (Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital)
  • 투고 : 2014.05.08
  • 심사 : 2014.06.16
  • 발행 : 2014.06.30
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초록

Pulmonary tumor thrombotic microangiopathy (PTTM) causing fatal pulmonary hypertension is a rare presentation of malignancy. In general, patients with PTTM rapidly succumb to death due to severe hypoxia. To date, very few cases of PTTM have been reported in the literature; and most of these cases were from gastric cancer and were diagnosed on post mortem autopsy, as it is extremely challenging to make an ante mortem diagnosis. We here report on a case of undiagnosed diffuse gastric cancer, presenting as worsening hypoxia. The clinical, radiographic, and echocardiographic features, and laboratory and pathological results were consistent with PTTM from gastric cancer. The patient was started on anticoagulation therapy, corticosteroids, and high-flow oxygen. However, her hypoxia worsened to the extent that she required ventilator support, and she died soon after intubation due to cardiac arrest. Since diffuse gastric cancer is associated with hereditary diffuse gastric cancer syndrome, cadherin 1 gene mutation analysis was performed to estimate the risk to her daughters. The test came back negative.

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참고문헌

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