Platelet-Derived Growth Factor Receptor-Tyrosine Kinase Inhibitor, Imatinib, Is Effective for Treating Pulmonary Hypertension Induced by Pulmonary Tumor Thrombotic Microangiopathy

被引:45
作者
Minatsuki, Shun [1 ]
Miura, Ichiro [2 ]
Yao, Atsushi [3 ]
Abe, Hiroyuki [4 ]
Muraoka, Hironori [1 ]
Tanaka, Mariko [4 ]
Imamura, Teruhiko [5 ]
Inaba, Toshiro [1 ]
Maki, Hisataka [1 ]
Hatano, Masaru [1 ]
Kinugawa, Koichiro [5 ]
Yao, Takashi [2 ]
Fukayama, Masashi [4 ]
Nagai, Ryozo [6 ]
Komuro, Issei [1 ]
机构
[1] Univ Tokyo, Grad Sch Med, Dept Cardiovasc Med, Tokyo 1138655, Japan
[2] Juntendo Univ, Sch Med, Dept Human Pathol, Tokyo 113, Japan
[3] Univ Tokyo, Div Hlth Serv Promot, Grad Sch Med, Tokyo 1138655, Japan
[4] Univ Tokyo, Dept Pathol, Grad Sch Med, Tokyo 1138655, Japan
[5] Univ Tokyo, Dept Therapeut Strategy Heart Failure, Grad Sch Med, Tokyo 1138655, Japan
[6] Jichi Med Univ, Shimotsuke, Tochigi, Japan
关键词
Circulatory disturbance; Cancer; Treatment; GASTRIC-CARCINOMA; OSTEOPONTIN EXPRESSION; ARTERIAL-HYPERTENSION; MESYLATE;
D O I
10.1536/ihj.14-220
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pulmonary hypertension (PH) induced by pulmonary tumor thrombotic microangiopathy (PTTM) can be fatal because its rapid progression confounds diagnosis, and it is difficult to control with therapy. Here we describe a woman with symptomatic PTTM-PH accompanying gastric cancer that was suspected from perfusion scintigraphy. PTTM-PH was diagnosed by gastroesophageal endoscopy and lung biopsy after partial control of PH using the platelet-derived growth factor (PDGF) receptor (PDGFR) tyrosine kinase inhibitor, imatinib. Treatment with sildenafil and ambrisentan further decreased PH, and she underwent total gastrectomy followed by adjuvant TS-1 chemotherapy. PH did not recur before her death from metastasis. Postmortem histopathology showed recanalized pulmonary arteries where the embolized cancer masses disappeared. PDGF-A, -B, and PDGFR-alpha, beta expression was detected in cancer cells and proliferating pulmonary vascular endothelial cells. Thus, PTTM-PH was successfully controlled using a combination of imatinib, drugs to treat pulmonary arterial hypertension, and cancer management.
引用
收藏
页码:245 / 248
页数:4
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