Signet-ring Cell Carcinoma of the Gallbladder Complicated by Pulmonary Tumor Thrombotic Microangiopathy

Yoshinori Ohno; Teru Kumagi; Taira Kuroda; Mitsuhito Koizumi; Nobuaki Azemoto; Hirofumi Yamanishi; Mayu Oda; Masashi Hirooka; Masanori Abe; Yoshio Ikeda; Bunzo Matsuura; Morikazu Onji; Yoshiko Soga; Yousuke Mizuno; Atsurou Sugita; Yoichi Hiasa

doi:10.2169/internalmedicine.53.1939

CASE REPORTS

Signet-ring Cell Carcinoma of the Gallbladder Complicated by Pulmonary Tumor Thrombotic Microangiopathy

Yoshinori Ohno, Teru Kumagi, Taira Kuroda, Mitsuhito Koizumi, Nobuaki Azemoto, Hirofumi Yamanishi, Mayu Oda, Masashi Hirooka, Masanori Abe, Yoshio Ikeda, Bunzo Matsuura, Morikazu Onji, Yoshiko Soga, Yousuke Mizuno, Atsurou Sugita, Yoichi Hiasa

Author information

Yoshinori Ohno
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Teru Kumagi
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Department of Community Medicine, Ehime University Graduate School of Medicine, Japan
Taira Kuroda
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Mitsuhito Koizumi
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Nobuaki Azemoto
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Hirofumi Yamanishi
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Mayu Oda
Residency Program, Ehime University Hospital, Japan
Masashi Hirooka
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Masanori Abe
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Yoshio Ikeda
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Bunzo Matsuura
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Morikazu Onji
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
Yoshiko Soga
Pathology Division, Ehime University Hospital, Japan
Yousuke Mizuno
Pathology Division, Ehime University Hospital, Japan
Atsurou Sugita
Pathology Division, Ehime University Hospital, Japan
Yoichi Hiasa
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan

Keywords: signet-ring cell carcinoma, gallbladder, pulmonary tumor thrombotic microangiopathy

JOURNAL OPEN ACCESS

2014 Volume 53 Issue 11 Pages 1125-1129

DOI https://doi.org/10.2169/internalmedicine.53.1939

Details

Abstract

Biliary drainage was performed in a 71-year-old man with obstructive jaundice of unknown origin; however, he died due to acute pulmonary failure. At autopsy, proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC) to the subserosa and bile ducts without growth toward the gallbladder lumen. Furthermore, fibrocellular intimal proliferation, tumor emboli and organized thrombi were observed in the small pulmonary arteries. The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM). PTTM may present as rapidly progressive dyspnea, and a high level of clinical suspicion is required to make the differential diagnosis.

Corresponding author

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