Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website https://www.jocmr.org

Case Report

Volume 14, Number 8, August 2022, pages 327-333

Urothelial Carcinoma With Pulmonary Tumor Thrombotic Microangiopathy After Chemotherapy for Hodgkin Lymphoma

Figures

Figure 1.
Figure 1. Fluorodeoxyglucose-positron emission tomography findings in the patient during HL treatment. FDG-PET: fluorodeoxyglucose-positron emission tomography; HL: Hodgkin lymphoma.
Figure 2.
Figure 2. Patient’s clinical course. ABVD: doxorubicin, bleomycin, vincristine and dacarbazine; EF: ejection fraction; TR: tricuspid regurgitation.
Figure 3.
Figure 3. Contrast-enhanced CT scan findings upon admission on day 1,208. (a) Chest CT scan. (b) Abdominal CT scan. CT computed tomography.
Figure 4.
Figure 4. Patient’s autopsy findings of the kidney. (a) Gross findings of the left kidney. (b, c) Urothelial carcinoma of the renal pelvis in hematoxylin and eosin-stained sections.
Figure 5.
Figure 5. Patient’s autopsy findings of the lung showing (a) some cancer cells and small number of thrombi, (b) fibrocellular intimal proliferation of small pulmonary arteries.
Figure 6.
Figure 6. Patient’s autopsy findings of the heart. (a) Gross findings of the heart. (b) Focal myocardial necrosis (arrows) in the hematoxylin and eosin-stained section. (c) Mild fibrosis in myocardial tissues around vessels, shown as blue Masson’s trichrome staining.

Table

Table 1. Laboratory Findings Upon Admission on Day 1,208
 
Laboratory findingsResults
WBCs: white blood cells; RBCs: red blood cells; PT: prothrombin time; INR: international normalized ratio; APTT: activated partial thromboplastin time; CRP: C-reactive protein; TP: total protein; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; ALP: alkaline phosphatase; γGTP: gamma-glutamyl transferase; BUN: blood urea nitrogen; Cre: creatinine; UA: uric acid; BS: blood sugar; HbA1c: hemoglobin A1c; BNP: brain natriuretic peptide; TG: triglyceride; HDL: high-density lipoprotein; LDL: low-density lipoprotein; IL-2R: interleukin-2 receptor; Ig: immunoglobulin.
Hematology
  WBCs6,100/µL
  RBCs355 × 104/µL
  Hemoglobin11.0 g/dL
  Hematocrit34.2%
  Platelet24.6 × 104/µL
  Segmented neutrophils79.7%
  Lymphocytes13.8%
  Monocytes5.2%
  Eosinophils1.0%
  Basophils0.3%
Coagulation
  PT INR1.19
  APTT39.2 s
  D-dimer16.06 µg/mL
Biochemistry
  CRP0.36 mg/dL
  TP6.9 g/dL
  Alb3.9 g/dL
  AST49 IU/L
  ALT33 IU/L
  LDH298 IU/L
  ALP246 IU/L
  γGTP63 IU/L
  Total bilirubin0.7 mg/dL
  BUN21.5 mg/dL
  Cre1.01 mg/dL
  UA5.8 mg/dL
  BS327 mg/dL
  HbA1c8.90%
  BNP662.2 pg/mL
  TG92 mg/dL
  HDL71 mg/dL
  LDL54 mg/dL
Serology
  IL-2R443 U/mL
  IgG1,095 mg/dL
  IgA289 mg/dL
  IgM61 mg/dL
Urinalysis
  pH6.5
  U-glucose3+
  U-protein1+
  U-blood2+