PMC5313427_01
Lung perfusion scans. (A) Panel A showed multiple subsegmental peripheral defects before chemotherapy. (B) The multiple defects improved after chemotherapy.
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A lung perfusion scan was performed and revealed multiple wedge-shaped subsegmental defects (Fig. 1A). The defects in the lung perfusion scan also showed some improvement (Fig. 1B). Two months after the first course of chemotherapy, her symptoms deteriorated again with the increase of TRPG.
Chest CT one month after admission revealed dilatation of the peripheral arteries and diffuse ground-glass opacities.
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HRCT showed dilatation of the peripheral pulmonary arteries and a diffuse patchy distribution of ground-glass opacity (GGO) in the bilateral lung fields (Fig. 2).
Time course of symptoms and treatments. TRPG and oxygenation improved after each course of chemotherapy (arrow).
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Her symptoms and the findings of PAH first improved, but then deteriorated repeatedly (Fig. 3).
Autopsy specimens of the lung revealed evidence of PTTM. (A) Papillary clusters of tumor cells adhered to arterial intima and intimal fibrous thickening occlude arterial lumen (arrow). Thrombus formation and recanalization of the arteries (arrowhead) are also observed [Hematoxylin and Eosin (H&E) staining, x200] (B) Tumor cells and intimal fibrocellular proliferation occlude the arterial lumen (arrow) (H&E staining, x400) (C) Intimal fibrocellular proliferation.The surrounding alveolar walls are mostly normal. (elastica van Gieson stain, x400).
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Autopsy findings of her lung showed multiple tumor embolisms, thrombus formation, recanalization, and intimal fibrocellular proliferation in the muscular pulmonary arteries measuring from 100 to 200 mum in diameter (Fig. 4).