Microscopic pulmonary tumor embolism secondary to adenocarcinoma of the prostate

Abstract

78歳男.1997年12月に骨転移を有する中分化型前立腺癌stage IV(T3bN0M1b, 1997年版TNM分類)と診断し, 両側精巣摘除術とflutamideによる治療を行っていた.1998年4月より一時測定感度以下に下がっていたPSAが再上昇しはじめ, 骨シンチグラフィーにて骨転移巣の増大も認めたため, ホルモン抵抗性再燃前立腺癌と診断し, estramustine phosphateの投与を開始した.1998年5月に乾性咳嗽を自覚.同年6月10日より急速に進行する呼吸困難が出現し, 6月13日に入院した.理学的所見では全身倦怠感とチアノーゼを認めた.肺動脈血栓症が疑われ酸素投与と抗凝固療法を行ったが呼吸困難は改善せず, 入院後4日目に死亡した.病理解剖所見では, 低分化型前立腺癌が多数の肺筋性動脈, 肝静脈, 肝内門脈内に播種しており, 前立腺癌由来の肺腫瘍塞栓による呼吸不全が死亡原因と診断した.詳細な臨床経過が記載されていた5例(本症例を含む)の肺腫瘍塞栓合併前立腺癌の報告例について検討した

We report a case of pulmonary tumor embolism involving multiple emboli from an unusual site, an adenocarcinoma of the prostate. A 78-year-old Japanese man was diagnosed with stage IV (1997 version of the TNM classification) moderately differentiated adenocarcinoma of the prostate in December 1997. He underwent bilateral orchiectomy and hormonal therapy with flutamide was started. The patient suffered from relapse in April 1998, and estramustine phosphate was administered as treatment for hormone-refractory prostate cancer. He noticed a dry cough in May 1998, and on June 13, he developed acute progressive dyspnea and was admitted to our hospital. Radiological findings, blood gas analysis, and clinical symptoms suggested pulmonary thrombosis. Despite anticoagulation and oxygen therapy, he remained severely dyspnoeic. He died of respiratory failure 4 days after admission. Autopsy confirmed dissemination of poorly differentiated adenocarcinoma of the prostate to the majority of the pulmonary muscular arteries.