P ulmonary tumor thrombotic microangiopathy (PTTM), a rare clinicopathological entity causing pulmonary hypertension in cancer patients, was first reported by von Herbay et al. in 1990 [1]. There are several reports of PTTM from Japan where the prevalence of gastric cancer is high, because gastric cancer is the malignancy that is most commonly associated with PTTM [2]. We report the fourth case of PTTM originating from metastatic prostate cancer. Case Presentation An 81-year-old Japanese man

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... h a history of old myocardial infarction and chronic obstructive pulmonary disease had been clinically diagnosed with prostate cancer approx. 8 years prior to his present admission (serum prostate-specific antigen [PSA] level 51.3 ng/mL, clinical stage T3bN0M0) and was treated with combined androgen blockade. However, the disease progressed gradually over the next 7 years and became castration resistant. Radiological assessment revealed multiple bone metastases. Although we recommended chemotherapy, he voluntarily discontinued his follow-up visits. Six months later, he was admitted to our hospital with dyspnea of a few days' duration, and loss of appetite that started 2 months previously. On admission, the patient was afebrile, with a blood pressure at 154/71 mmHg and a heart rate of 80 beats/min. Peripheral oxygen saturation was 90% on room air. His PSA level was highly elevated at 696.2 ng/mL; alkaline phosphatase was 7,672 U/L, http ://escholarship.lib.okayama-u.ac.jp/amo/ Case Report Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal, malignancy-related respiratory complication; we herein report a PTTM case induced by metastatic prostate cancer. An 81-year-old Japanese man developed dyspnea. High-resolution computed tomography (HRCT) revealed ground-glass opacities spread across bilateral lung fields. Pulmonary microvascular aspiration cytology detected prostate cancer cells. As PTTM was highly suspected, docetaxel chemotherapy was performed immediately. His respiratory condition and HRCT findings improved temporarily, but he died approx. 6 weeks after admission. Autopsy showed fibrocellular intimal proliferation of small pulmonary arterioles, which confirmed the diagnosis of PTTM induced by prostate cancer. As in the present case, it is often difficult to confirm the presence of not only tumor embolization but also fibrocellular intimal proliferation before the patient's death.