Figure 4.

42-year-old previously healthy man presented to the hospital with 6 weeks of progressively worsening exertional dyspnea and non-productive cough diagnosed with pulmonary tumor thrombotic microangiopathy (PTTM) secondary to gastric adenocarcinoma. (a) Hematoxylin and eosin stained tissue (10×) shows medium sized blood vessels (small arrow) containing tumor emboli. (b), Hematoxylin and eosin stained tissue (20×) shows a singular blood vessel containing nests of tumor cells (small arrowhead) surrounded by fibrin debris. (c) Verhoeff's elastic stained tissue shows tumor thrombus with fibrocellular intimal proliferation (large arrow) within blood vessel (20×). (d) shows the same blood vessel shown in (b) stained with Verhoeff's elastic stain to highlight vessel wall (large arrowhead) (40×).