BACKGROUND 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 late...BACKGROUND 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.CASE SUMMARY 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.CONCLUSION 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.展开更多
BACKGROUND Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells(NECs)that extend beyond the basement membrane.They often coexist with other lung diseases such as fibrosis and bronchiectasis,but rarely acc...BACKGROUND Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells(NECs)that extend beyond the basement membrane.They often coexist with other lung diseases such as fibrosis and bronchiectasis,but rarely accompanied by pulmonary sclerosing pneumocytoma(PSP),which has not been reported in the literature.CASE SUMMARY A 54-year-old woman was admitted to the hospital because she had symptoms of bloody sputum for more than 4 mo and hemoptysis for 1 wk.Computed tomography images showed atrophy accompanied by infections in the middle lobe of her right lung.Moreover,numerous nodules were identified in the middle lobe of the right lung.The patient underwent thoracoscopic pneumonectomy of the middle lobe of the right lung,and the resected mass was pathologically confirmed to have bronchiectasis,multifocal NEC hyperplasia accompanied by tumorlet,and PSP.CONCLUSION Our report presents a rare clinical case of bronchiectasis complicated with multifocal NEC hyperplasia,tumorlet,and PSP.展开更多
Background The result would be disastrous if the superior pulmonary sulcus tumor （Pancoast tumor） was misdiagnosed as degenerative cervical spine diseases. The aim of this study was to investigate the differential d...Background The result would be disastrous if the superior pulmonary sulcus tumor （Pancoast tumor） was misdiagnosed as degenerative cervical spine diseases. The aim of this study was to investigate the differential diagnosis methods of cervical radiculopathy and superior pulmonary sulcus tumor. Methods Clinical manifestations, physical, and radiological findings of 10 patients, whose main complaints were radiating shoulder and arm pain and later were diagnosed with superior pulmonary sulcus tumor, were reviewed and compared with those of cervical radiculopathy. Results Superior pulmonary sulcus tumor patients have shorter mean history and fewer complaints of neck pain or limitation of neck movement. Physical examination showed almost normal cervical spine range of motion. Spurling＇s neck compression test was negative in all patients. Anteroposterior cervical radiographs showed the lack of pulmonary air at the top of the affected lung in all cases and first rib encroachment in one case. The diagnosis of superior pulmonary sulcus tumor can be further confirmed by CT and MRI. Conclusions By the method of combination of history, physical examination, and radiological findings, superior pulmonary sulcus tumor can be efficiently differentiated from cervical radiculopathy. Normal motion range of the cervical spine, negative Spurling＇s neck compression test, and the lack of pulmonary air at the top of the affected lung in anteroposterior cervical radiographs should be considered as indications for further chest radiograph examinations.展开更多
文摘BACKGROUND 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.CASE SUMMARY 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.CONCLUSION 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.
文摘BACKGROUND Pulmonary tumorlets are nodular hyperplastic neuroendocrine cells(NECs)that extend beyond the basement membrane.They often coexist with other lung diseases such as fibrosis and bronchiectasis,but rarely accompanied by pulmonary sclerosing pneumocytoma(PSP),which has not been reported in the literature.CASE SUMMARY A 54-year-old woman was admitted to the hospital because she had symptoms of bloody sputum for more than 4 mo and hemoptysis for 1 wk.Computed tomography images showed atrophy accompanied by infections in the middle lobe of her right lung.Moreover,numerous nodules were identified in the middle lobe of the right lung.The patient underwent thoracoscopic pneumonectomy of the middle lobe of the right lung,and the resected mass was pathologically confirmed to have bronchiectasis,multifocal NEC hyperplasia accompanied by tumorlet,and PSP.CONCLUSION Our report presents a rare clinical case of bronchiectasis complicated with multifocal NEC hyperplasia,tumorlet,and PSP.
文摘Background The result would be disastrous if the superior pulmonary sulcus tumor （Pancoast tumor） was misdiagnosed as degenerative cervical spine diseases. The aim of this study was to investigate the differential diagnosis methods of cervical radiculopathy and superior pulmonary sulcus tumor. Methods Clinical manifestations, physical, and radiological findings of 10 patients, whose main complaints were radiating shoulder and arm pain and later were diagnosed with superior pulmonary sulcus tumor, were reviewed and compared with those of cervical radiculopathy. Results Superior pulmonary sulcus tumor patients have shorter mean history and fewer complaints of neck pain or limitation of neck movement. Physical examination showed almost normal cervical spine range of motion. Spurling＇s neck compression test was negative in all patients. Anteroposterior cervical radiographs showed the lack of pulmonary air at the top of the affected lung in all cases and first rib encroachment in one case. The diagnosis of superior pulmonary sulcus tumor can be further confirmed by CT and MRI. Conclusions By the method of combination of history, physical examination, and radiological findings, superior pulmonary sulcus tumor can be efficiently differentiated from cervical radiculopathy. Normal motion range of the cervical spine, negative Spurling＇s neck compression test, and the lack of pulmonary air at the top of the affected lung in anteroposterior cervical radiographs should be considered as indications for further chest radiograph examinations.
