Analysis of intraoperative frozen section diagnosis of 1 263 pulmonary nodules / 中国胸心血管外科临床杂志

@#Objective    To explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases. Methods    The intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to January 2022 were collected. The main causes of misdiagnosis in frozen section diagnosis were analyzed, and the main points of diagnosis and differential diagnosis were summarized. Results    According to the inclusion criteria, a total of 1 263 frozen section diagnosis results of 1 178 patients were included in the study, including 475 males and 703 females, with an average age of 58.7 (23-86) years. In 1 263 frozen section diagnosis results, the correct diagnosis rate was 95.65%, and the misdiagnosis rate was 4.35%. There were 55 misdiagnoses, including 18 (3.44%) invasive adenocarcinoma, 17 (5.82%) adenocarcinoma in situ, 7 (35.00%) mucinous adenocarcinoma, 4 (2.09%) minimally invasive adenocarcinoma, 3 (100.00%) IgG4 related diseases, 2 (66.67%) mucinous adenocarcinoma in situ, 1 (16.67%) atypical adenomatous hyperplasia, 1 (14.29%) sclerosing pulmonary cell tumor, 1 (33.33%) bronchiolar adenoma, and 1 (100.00%) papillary adenoma. Conclusion    Intraoperative frozen section diagnosis still has its limitations. Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.

Analysis of influencing factors for complications during percutaneous radiofrequency ablation of pulmonary tumor / 中国胸心血管外科临床杂志

@# Objective    To explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. Methods    We retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. Results    A total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. Conclusion    Percutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.

The effect of narrative nursing on the meaning and quality of life in chemotherapy patients with advanced lung cancer / 中国实用护理杂志

Objective:To explore the impact of narrative nursing on the meaning and quality of life in chemotherapy patients with advanced lung cancer.Methods:A total of 86 chemotherapy patients with advanced lung cancer hospitalized in the Oncology Department of Shanghai Pulmonary Hospital Affiliated to Tongji University from October 2020 to November 2021 were selected and divided into control group with 42 cases and narrative group with 44 cases by random number table method. The control group was treated with routine nursing of patients with tumor chemotherapy while the narrative group was implemented on narrative nursing intervention as well as routine nursing. A total of 12 to 14 times, each chemotherapy period was 7 times. The effect of the intervention was assessed by Meaning in Life Scale for Advanced Cancer Patients (MiLS)、Chinese Version of the Functional Assessment of Cancer Therapy-Lung(FACT-L 4.0) and Distress Thermometer (DT) before intervention, 1 week, 3 weeks and 2 months after intervention.Results:Forty cases in the control group and 42 cases in the narrative group were involved in the statistical analysis. Two months after intervention, the total score of MiLS, the score of the will to search for meaning, the meaning of life and satisfaction,existential frustration, life control, suffering tolerance and death acceptance in the control group were (98.60 ± 9.17), (14.90 ± 1.91), (13.38 ±2.62), (16.40 ± 2.73), (26.48 ± 3.19), (14.30 ± 1.68), (13.15 ± 3.07) points, which were significantly lower than those in the narrative group (112.02 ± 9.73), (16.45 ± 2.24), (16.31 ± 1.96), (19.40 ± 2.42), (28.76 ±3.48), (16.14 ± 1.82), (14.95 ± 2.39) points, and the difference were statistically significant ( t value were -6.42 --2.98, all P<0.01), and the main effect between groups and time were statistically significant ( F values were 2.76-24.47, all P<0.05). Two months after intervention, the total score of FACT-L, social/family status, emotional status, functional status and lung cancer specific module in control group were (90.75 ± 11.65), (18.58 ± 3.75), (15.65 ± 3.85), (13.48 ± 3.34), (22.00 ± 4.93) points, which were lower than those in the narrative group (102.12 ± 9.32), (20.36 ± 4.29), (18.10 ± 3.25), (16.74 ± 4.05), (24.80 ±3.83) points, the differences were statistically significant ( t values were-4.89--1.99, all P<0.05), and there was intergroup effect ( F values were 5.14-24.47, all P<0.05). Three weeks and 2 months after intervention, the psychological distress score of control group were (3.88 ± 2.73), (3.60 ± 2.19) points, which were significantly higher than the narrative group (2.52 ± 2.18), (1.90 ± 1.78) points, and the differences were statistically significant ( t=2.50, 3.85, both P<0.05), with a time, groups, interaction effect ( F=15.29, 15.86, 2.80, all P<0.05). Conclusions:Narrative nursing can effectively improve the meaning and quality of life and relieve psychological distress in chemotherapy patients with advanced lung cancer. It is worthy of clinical promotion.

Tumor fibroso solitario de la pleura / Solitary fibrous tumor of the pleura

El tumor fibroso solitario de la pleura (TFSP) representa una neoplasia benigna de evolución habitualmente silente, hallazgo incidental y heterogeneidad en su presentación. Raramente se malignizan y la sintomatología se relaciona fundamentalmente con el compromiso por compresión de las estructuras vecinas. Su tratamiento es la cirugía. Se describe el caso de un paciente masculino de 49 años con antecedentes de hipertensión arterial, diabetes mellitus y obesidad que consultó al Servicio de urgencias por disnea. Se solicitó tomografía de tórax que evidenció voluminosa masa de densidad de partes blandas en hemitórax izquierdo con desplazamiento del mediastino y descenso del diafragma del mismo lado. La fibrobroncoscopia no evidenció lesión endoluminal. Fue evaluado por Cirugía del Tórax. Se realizó abordaje de la masa mediante toracotomía postero lateral izquierda. El estudio anatomopatológico informó formación tumoral de 25 × 16 × 13 cm, peso de 1905 gr y en la microscopía se describió proliferación celular fibroblástica, células fusiformes de núcleos pequeños ovoides y escaso citoplasma dispuestas en haces desordenados con colágeno interpuesto. La inmunohistoquímica informó vimentina y CD34 positivos. Se realizó el diagnóstico de tumor fibroso solitario de la pleura. La evolución posterior fue buena.

The solitary fibrous tumor of the pleura (SFTP) represents a benign neoplasm of commonly silent evolution, incidental finding and heterogeneous presentation. It rarely becomes malignant and symptoms mainly result from the involvement of neighboring structures due to compression. It is treated with surgery. We describe the case of a 49-year-old male patient with history of arterial hypertension, diabetes mellitus and obesity who consulted the Emergency Services because he was experiencing dyspnea. We requested chest tomography that showed a voluminous soft tissue density mass in the left hemithorax with mediastinal shift and decreased diaphragm on the same side. The fibrobronchoscopy didn't show endoluminal lesion. The patient was evaluated by the Thorax Surgery staff. The mass was treated by means of left posterolateral thorachotomy. The anatomopathological study reported the formation of a tumor of 25 × 16 ×13 cm and 1905 gr, and the microscopy described fibroblast cell proliferation, spindle cells of small ovoid nuclei and very little cytoplasm placed in disorganized bundles with collagen interposition. The immunohistochemistry disclosed positive vimentin and CD34. The patient was diagnosed with solitary fibrous tumor of the pleura, with good subsequent evolution.

Application of pre-hospital prerehabilitation strategy based on enhanced recovery after surgery (ERAS) concept in patients with pulmonary tumor / 中国实用护理杂志

Objective@#To explore the practical effect of pre-hospital prehabilitation strategy in pulmonary tumor patients.@*Methods@#A total of 68 patients receiving thoracic surgery in Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute & Hospital, during July 2018 to April 2019, were divided into pre-hospital prehabilitation group (n=34) and control group (n=34), according to the order of outpatient. Patients in control group received routine guidance before thoracic surgery, and those in pre-hospital prehabilitation group received a home-based preoperative intervention. The differences of 6-minute walking distance (6MWD), hospital anxiety and depression score (HADS), forced expiratory volume at the first second (FEV1), forced vital capacity (FVC), postoperative thoracic drainage and complications were compared between the two groups.@*Results@#The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (611.08±47.13) m, (2.48±0.51) L and (3.43±0.48) L on one day preoperatively, respectively, while in the control group, the values were (520.26±57.33) m, (2.19±0.38) L and (3.17±0.58) L, respectively, with statistically significant differences, t=7.136, 2.659, 2.014, P<0.05. The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (540.27±85.73) m, (2.07±0.46) L and (2.98±0.67) L at 30 days postoperatively, respectively, while in the control group, the values were (488.86±75.04) m, (1.82±0.51) L and (2.42±0.58) L, respectively, with statistically significant differences, t=2.631, 2.122, 3.685, P<0.05. The thoracic drainage of pre-hospital prehabilitation group and control group were (162.35±43.08) ml and (191.42±69.11) ml, respectively, t=2.081, P<0.05. In addition, the occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and arrhythmia were 0.0%(0/34), 2.9%(1/34), 0.0%(0/34) in the pre-hospital prehabilitation group, while those were 2.9%(1/34), 8.8%(3/34), 14.7%(5/34) in the control group, pre-hospital prehabilitation group had a significant reduction in the occurrence of arrhythmia (P<0.05).@*Conclusions@#The pre-hospital prehabilitation strategy significantly improve the perioperative functional status and prognosis of lung cancer patients, and reduce the occurrence of postoperative complications to a certain extent, which is worth of being further promoted clinically.

Tumorectomy to Avoid Sudden Death by Pulmonary Embolism in a Patient with a Cardiac Tumor Originating from the Esophagus / 日本心臓血管外科学会雑誌

Tumor metastasis to the endocardium is rare. The patient was 58-year-old man who was given a diagnosis of a metastatic tumor to the right atrium and right ventricle. The tumor originated from the esophagus, and the patient was at risk of sudden death caused by acute pulmonary embolism. We performed tumorectomy to reduce the risk of sudden death. The postoperative course was satisfactory, and the tumorectomy was followed by chemotherapy. The 5-year survival rate in such cases has been reported to be only approximately 11%. However, resection of tumor mass may be useful for improving postoperative QOL and reducing the risk of sudden death.

Application of pre-hospital prerehabilitation strategy based on enhanced recovery after surgery (ERAS) concept in patients with pulmonary tumor / 中国实用护理杂志

Objective To explore the practical effect of pre-hospital prehabilitation strategy in pulmonary tumor patients. Methods A total of 68 patients receiving thoracic surgery in Department of Pulmonary Oncology, Tianjin Medical University Cancer Institute & Hospital, during July 2018 to April 2019, were divided into pre-hospital prehabilitation group (n=34) and control group (n=34), according to the order of outpatient. Patients in control group received routine guidance before thoracic surgery, and those in pre- hospital prehabilitation group received a home- based preoperative intervention. The differences of 6-minute walking distance (6MWD), hospital anxiety and depression score (HADS), forced expiratory volume at the first second (FEV1), forced vital capacity (FVC), postoperative thoracic drainage and complications were compared between the two groups. Results The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (611.08±47.13) m, (2.48±0.51) L and (3.43±0.48) L on one day preoperatively, respectively, while in the control group, the values were (520.26±57.33) m, (2.19± 0.38) L and (3.17±0.58) L, respectively, with statistically significant differences, t=7.136, 2.659, 2.014, P<0.05. The values of 6MWD, FEV1 and FVC in the pre-hospital prehabilitation group were (540.27±85.73) m, (2.07±0.46) L and (2.98±0.67) L at 30 days postoperatively, respectively, while in the control group, the values were (488.86±75.04) m, (1.82±0.51) L and (2.42±0.58) L, respectively, with statistically significant differences, t=2.631, 2.122, 3.685, P<0.05. The thoracic drainage of pre-hospital prehabilitation group and control group were (162.35 ± 43.08) ml and (191.42 ± 69.11) ml, respectively, t=2.081, P<0.05. In addition, the occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and arrhythmia were 0.0%(0/34), 2.9%(1/34), 0.0%(0/34) in the pre-hospital prehabilitation group, while those were 2.9%(1/34), 8.8%(3/34), 14.7%(5/34) in the control group, pre-hospital prehabilitation group had a significant reduction in the occurrence of arrhythmia (P<0.05). Conclusions The pre- hospital prehabilitation strategy significantly improve the perioperative functional status and prognosis of lung cancer patients, and reduce the occurrence of postoperative complications to a certain extent, which is worth of being further promoted clinically.

Sudden Unexpected Death During Bronchoscopy of a Patient with Pulmonary Lymphangitic Carcinomatosis and Pulmonary Tumor Thrombotic Microangiopathy due to Gastric Cancer / 대한법의학회지

We present the case of a 48-year-old woman who complained of sustained dyspnea and newly developed dyspnea, who then suddenly and unexpectedly expired during bronchoscopy. On postmortem examination, the deceased had advanced gastric cancer as a primary tumor. Frequent lymphatic tumor emboli were observed with some pulmonary lymphangitic carcinomatosis (PLC), and pulmonary tumor thrombotic microangiopathy (PTMA). PLC and PTMA are lethal forms of pulmonary metastasis, and PTMA can lead to sudden death. The characteristic findings of PLC and PTMA in the deceased were not predominant, however, and the clinical manifestation was not acutely deteriorating. These findings are, therefore, insufficient to explain the deceased's sudden death. Clinically, the deceased manifested hypoxemia, bradycardia and cardiac arrest during bronchoscopy and then soon expired, suggesting the possibility of cardiovascular complication related to bronchoscopy. Despite several limitations, we assumed that the sudden unexpected death might have been induced by cardiovascular complications related to bronchoscopy and due to the underlying pathologic condition by PLC and PTMA.

Comparison of preoperative PET-CT and pathological analyses in diagnosis of pulmonary tumors / 实用医学杂志

Objective To investigate the consistency in 18F-deoxyglucose positron emission tomography (18F-FDG PET-CT) examination and histopathological analyses in the diagnoses of resectable lung tumors. Methods Retrospective reviews over the clinical data of lung tumor patients by preoperative PET-CT diagnosis and postoperative histopathological diagnosis were conducted to investigate the effects of the two diagnostic methods in terms of lung tumor properties , mediastinal lymph node metastasis , and pulmonary hilar lymph node metastasis. Results The diagnoses by preoperative PET-CT was consistent in differentiation of non-malignancy and malignancy of pathologic lung tumors by 87.3%, at a medium level (κ = 0.401, P < 0.001). McNemar test showed P = 0.508, indicating the two diagnostic methods were insignificantly different in the diagnosis of pulmonary tumors. The preoperative PET-CT was consistent in the diagnosis of the metastasis of pathologic mediastinal lymph node by 85.9%, at a medium level (κ = 0.697, P < 0.001). McNemar test showed P =0.754, indicating no significant difference between the diagnostic methods. The preoperative PET-CT was consistent with postoperative pathological examinations in the differentiations of the metastasis of pulmonary and hilar lymph node by 77.4%, at a medium level (κ=0.523, P < 0.001). McNemar test showed P = 0.454, indicating the two diagnostic methods were no significantly different. Conclusion Preoperative PET-CT and histopathologic examinations may be consistent in lung tumor diagnosis , which provides a basis for a certain significance in the surgical options.

A Case Report: Cavitary Infarction Caused by Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Pancreatic Intraductal Papillary Mucinous Neoplasm

Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

Carcinomatosis linfática y embolismo tumoral pulmonar / Lymphangitic Carcinomatosis and Pulmonary Tumor Embolism

La linfangitis carcinomatosa es un trastorno relativamente poco común caracterizado por la infiltración difusa de los vasos linfáticos pulmonares por cáncer metastásico. Es una manifestación tardía que implica mal pronóstico. El diagnóstico puede ser difícil y requiere de un alto índice de sospecha. La embolia pulmonar tumoral es la presencia de múltiples acúmulos de células tumorales en las pequeñas arterias, arteriolas y capilares septales del pulmón. La oclusión de la microvasculatura pulmonar por células tumorales y trombos asociados puede producir una entidad clínica subaguda y progresiva que se asemeja a la enfermedad tromboembólica . Algunas modalidades de imágenes pueden ayudar a definir el diagnóstico, especialmente gammagrafía pulmonar de ventilación-perfusión y su característico patrón de múltiples defectos de perfusión sub- segmentarios periféricos sin alteraciones ventilatorias o en la angiografía. El tratamiento no ha sido ampliamente estudiado, ya que el diagnóstico por lo general no se realiza hasta después de la muerte. Se realiza una revisión de la literatura sobre la evaluación y el diagnóstico de estas dos entidades clínicas poco frecuentes.

Lymphangitic carcinomatosis is a relatively uncommon disorder characterized by diffuse infiltration of the pulmonary lymphatics by metastatic cancer. It is a late manifestation of malignancy that implies bad prognosis. The diagnosis can be difficult and requires a high degree of suspicion. Microscopic pulmonary tumor embolism is the presence of multiple aggregates of tumor cells in the small pulmonary arteries, arterioles and septal capillaries. Occlusion of the pulmonary microvasculature by tumor cells and associated thrombi can produce a subacute and progressive clinical entity that resembles thromboembolic disease. Some imaging studies may help to define the diagnosis, especially the ventilation-perfusion lung scan and its typical pattern of multiple peripheral sub-segmental perfusion defects without ventilatory abnormalities or the angiography. Treatment for this entity has not been extensively studied, since the diagnosis is usually made postmortem. We provide a review of the literature about the evaluation and diagnosis of these two infrequent clinical entities.

Pulmonary Tumor Thrombotic Microangiopathy Associated with Advanced Gastric Cancer Successfully Treated with Chemotherapy / 이화의대지

Pulmonary tumor thrombotic microangiopathy (PTTM) is an uncommon and fatal malignancy-related pulmonary complication characterized by fibrocellular intimal proliferation of small pulmonary arteries and arterioles. It causes marked pulmonary hypertension, right-side heart failure, and sudden death. Diagnosis of PTTM is extremely difficult while the patient is alive. Here, we report a 44-year-old woman who presented with complaining of progressing dyspnea and pulmonary hypertension but with no history of cancer. She was diagnosed with PTTM caused by advanced gastric cancer ante mortem and was treated effectively with chemotherapy.

Occult Gastric Cancer Presenting as Hypoxia from Pulmonary Tumor Thrombotic Microangiopathy

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.

A Case of Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Advanced Gastric Cancer / 대한내과학회지

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.

A Case of Pulmonary Tumor Thrombotic Microangiopathy in a Patient with Advanced Gastric Cancer / 대한내과학회지

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and fatal cancer-related pulmonary complication leading to severe pulmonary hypertension, right heart failure, and death. Few cases of PTTM have been diagnosed antemortem. A 62-year-old male showing complete remission of gastric cancer presented with exertional dyspnea. Transthoracic echocardiography showed marked dilation of the right atrium, right ventricle, and the small left ventricle with normal left ventricular function. Right heart catheterization also showed mild to moderate pulmonary hypertension. A chest computed tomography scan revealed no evidence of acute pulmonary thromboembolism, but it showed consolidations with subpleural nodules in both lower lobes, and a lung perfusion scan showed multifocal, non-segmental perfusion defects. Finally, a diagnostic lung biopsy with video-assisted thoracoscopic surgery was performed, and the pathologic findings were compatible with PTTM. Here, we report a case of gastric cancer-related PTTM that was diagnosed antemortem.

A Case of Thyroid Papillary Carcinoma With Pulmonary Tumor Embolism

The tumor embolism is defined as tumor cells within the vascular system such as pulmonary artery that is not contiguous with the other metastatic foci. The incidence of tumor embolism varies widely ranging from 3% to 26% among several studies; whereas lung cancer, prostate cancer, colorectal cancer, breast cancer, pancreas cancer are associated with high risks for tumor embolism. However thyroid cancer is rarely associated with tumor embolism. Among the rare cases, tumor embolism was reported as being mostly of follicular carcinoma or undifferentiated carcinoma, but few of papillary carcinoma. We report an unusual presentation that pulmonary tumor embolism from thyroid papillary carcinoma was diagnosed with positron emission tomography/computed tomography (CT) and chest CT.

A Case of Locally Advanced Breast Cancer Complicated by Pulmonary Tumor Thrombotic Microangiopathy / Journal of the Korean Cancer Association, 대한암학회지

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare, malignancy-related complication that causes marked pulmonary hypertension, right heart failure, and death. We report on a patient with locally advanced breast cancer whose course was complicated by fatal PTTM based on clinical and laboratory findings.

Pulmonary tumor thrombotic microangiopathy in a patient with breast cancer / 대한내과학회지

Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare malignancy-related complication causing severe pulmonary hypertension, right heart failure, and death. PTTM is characterized by diffuse fibrocellular intimal proliferation and multiple thrombi formation in the pulmonary arteries and arterioles, which result from invasion of the pulmonary blood vessels by tumor cells. Establishing the diagnosis of PTTM is very difficult and few cases are diagnosed ante mortem. We report the case of a 48-year-old woman diagnosed with PTTM before death who developed breast cancer and presented with persistent dyspnea on exertion.

Retroperitoneal Yolk Sac Tumor in Adult Woman Presenting as Spinal Cord Compression and Fatal Pulmonary Tumor Embolism

A 35-year-old woman, previously treated for systemic metastases from retroperitoneal yolk sac tumor, presented with progressive painful paraparesis. Preoperative images showed severe cord compression by the metastatic infiltration of the lumbar vertebrae and epidural mass as well as a huge retroperitoneal mass. While performing unremarkable surgery in prone position, the patient abruptly fell into hypoxic insults and circulatory arrest. Intraoperative pulmonary tumor embolism was deemed a cause of death. When planning operative procedure for this dangerous malignancy, scrupulous manipulation is mandated and the possibility of fatal pulmonary tumor embolism should also be addressed and fully discussed preoperatively.

The Dynamic CT Study of Peripheral Lung Cancer and Pulmonary Inflammatory Pseudotumor / 实用放射学杂志

Objective To investigate the dynamic CT features of peripheral lung cancer (PLC) and pulmonary inflammatory pseudotumor(IPT).Methods 23 patients with PLC and 6 patients with IPT were undergone plain and dynamic enhanced CT scans (beginning at 30 s after the onset of injection,serial scan were obtained at 30 s intervals within 180 s) before surgery or administration of antibiotic.Results The average CT values of plain CT,CT enhanced attenuation at 30 s and 90 s were significantly different between PLC and IPT.There were no significant decline following peak enhancement in IPT but PLC within 180 s.Conclusion The comprehensive analysis of plain CT value,enhanced CT value at 30 s,and the decreasing rate after 90 s of administration of contrast material may be useful in differential diagnosis between PLC and IPT.