A case of renal cell carcinoma with microscopic pulmonary tumor embolism proven by surgical lung biopsy

Takuma Katano; Toyonori Tsuzuki; Hiroki Numanami; Naoto Sassa; Toshio Kato; Akihito Kubo; Satoru Ito

doi:10.1016/j.rmcr.2022.101716

A case of renal cell carcinoma with microscopic pulmonary tumor embolism proven by surgical lung biopsy

Respir Med Case Rep. 2022 Jul 31:39:101716. doi: 10.1016/j.rmcr.2022.101716. eCollection 2022.

Authors

Takuma Katano¹, Toyonori Tsuzuki², Hiroki Numanami³, Naoto Sassa⁴, Toshio Kato¹, Akihito Kubo^{1

5}, Satoru Ito¹

Affiliations

¹ Department of Respiratory Medicine and Allergology, Aichi Medical University, Nagakute, Japan.
² Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan.
³ Division of Chest Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan.
⁴ Department of Urology, Aichi Medical University, Nagakute, Japan.
⁵ Medical Oncology, Oncology Center, Aichi Medical University Hospital, Nagakute, Japan.

Abstract

Pulmonary tumor embolism (PTE) is difficult to diagnose before death. We report the case of a 75-year-old man with microscopic PTE of renal cell carcinoma who was diagnosed by surgical lung biopsy. He visited our hospital because of dyspnea on exertion. Chest computed tomography (CT) showed multiple micronodules and ground glass opacities. Steroid therapy was started as therapeutic diagnosis for IgG4-related pulmonary disease. However, he was admitted our hospital due to progressive respiratory failure. Pathological findings of a lung biopsy obtained by video-assisted thoracic surgery showed PTE of renal cell carcinoma without embolization of large pulmonary arteries. He received palliative medicine and died four months after the surgical lung biopsy. In cases of multiple micronodules in chest CT findings and worsened respiratory symptoms, PTE should be considered in the differential diagnosis.

Keywords: GGO, ground glass opacities; Micronodules; PTE, pulmonary tumor embolism; Pulmonary tumor embolism; Renal cell carcinoma; Respiratory failure; SpO2, peripheral oxygen saturation; Surgical lung biopsy; mMRC, modified Medical Research Council dyspnea scale.

Publication types

Case Reports