Pulmonary tumor thrombotic microangiopathy associated with prostate cancer achieving over 10-year survival: a case report

Abstract Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and often fatal pulmonary complication of malignancy, characterized by rapidly progressive pulmonary hypertension and difficulty in ante-mortem diagnosis. We report a case of PTTM associated with previously untreated metastatic prostate cancer in a 62-year-old man with an initial serum prostate-specific antigen level of 3,835 ng/mL and clinical stage cT3N0M1. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) performed during the diagnostic workup revealed findings suggestive of pulmonary hypertension and right heart strain before the onset of overt respiratory failure. Shortly after prostate biopsy, the patient developed acute hypoxemic respiratory failure. Based on the clinical suspicion of PTTM, hormonal therapy was initiated promptly before pathological confirmation, resulting in rapid improvement of respiratory status. A definitive diagnosis of PTTM was subsequently established by pulmonary artery aspiration cytology obtained via right heart catheterization. The patient has remained alive for more than 10 years without recurrence of PTTM. This appears to represent the longest survival reported for PTTM to date. This case highlights the importance of early clinical suspicion and prompt cancer-directed therapy in patients with suspected PTTM.