Incidence and clinical significance of tumor embolization to the lungs

doi:10.1016/0002-9343(68)90044-2

The American Journal of Medicine

Volume 45, Issue 2, August 1968, Pages 271-290

https://doi.org/10.1016/0002-9343(68)90044-2 Get rights and content

Abstract

The incidence and clinical significance of tumor embolization to the lungs was determined from the autopsy and clinical records of 366 patients dying with either carcinoma of the breast, carcinoma of the stomach, hepatoma, hypernephroma or choriocarcinoma. Ninety-five (26 per cent) of the patients reviewed had some degree of tumor embolization and in thirty (8.3 per cent) the emboli were a significant factor in the death of the patient. Ten patients whose death was directly attributable to tumor emboli are reviewed in detail. The clinical spectrum of tumor embolization was detailed by analysis of these ten cases and of twenty-three cases of tumor embolization previously recorded.

Pulmonary vascular obstruction due to tumor embolization is a previously little emphasized clinical entity which is probably much more prevalent than currently recognized. Many patients with tumor emboli are the obvious victims of widespread incurable cancer and accurate diagnosis of embolization in these patients is currently academic. However, tumor embolization may lead to the first clinical manifestations of an occult carcinoma and thus may permit early detection and treatment of the primary tumor. Tumor emboli are not necessarily to be regarded as metastases since there is good evidence that the majority of such tumor fragments are destroyed within the vessel lumen without any evidence of parenchymal invasion.

Tumor embolization should be considered in the differential diagnosis of pulmonary infarction, idiopathic pulmonary hypertension or respiratory distress syndromes when minimal roentgenographic abnormalities are present. This is especially true when these manifestations occur in (1) young women with recent bizarre menstrual histories, (2) patients with unexplained hepatomegaly or (3) patients with systemic complaints such as weight loss, anorexia and weakness. Pregnancy tests and liver scans are potentially of value in screening this group for the presence of malignancy. As cancer chemotherapy improves, it will become increasingly important to recognize tumor emboli syndromes as manifestations of occult carcinoma.

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¹: From the Departments of Medicine and Pathology, the Johns Hopkins University School of Medicine and the Johns Hopkins Hospital, Baltimore, Maryland 21205.

^†: Present address: Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104.

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ReviewIncidence and clinical significance of tumor embolization to the lungs

Abstract

Am. J. Obst. & Gynec.

Lancet

Am. J. Obst. & Gynec.

J. Thoracic Cardioaasc. Surg.

Ueber Krebszellenembolien in den Lungenarterien

Zentralbl. allg. Path.

A case of hydatidiform mole with multiple small syncytial infarctions of the lungs

Subacute cor pulmonale

Arch. Int. Med.

Pulmonary syncytial giant cell embolism

Obst. & Gynec.

Subacute cor pulmonale following trophoblastic pulmonary emboli

Canad. M. A. J.

Trophoblastic pulmonary thrombosis with cor pulmonale

J. A. M. A.

Cor pulmonale due to tumor emboli. Review of literature and report of a case

J. A. M. A.

Death from pulmonary embolism associated with hydatidiform mole

Am. J. Obst. & Gynec.

Pulmonary embolization from primary hepatic carcinoma

Arch. Int. Med.

Case Records of the Massachusetts General Hospital

New England J. Med.

Pulmonary carcinomatous thrombo-embolism

Acta path. et microbiol. scandinav.

Review
Incidence and clinical significance of tumor embolization to the lungs