Metastatic Low-Grade Serous Ovarian Cancer Causing Severe Pulmonary Hypertension

What happened, in summary

A 78-year-old woman with recurrent Stage IV low-grade serous ovarian cancer was admitted after 2 weeks of worsening shortness of breath and a rapid decline in exercise tolerance. Her original cancer treatment in 2006 included right salpingo-oophorectomy, omentectomy, and pelvic lymph node surgery. She then took anastrozole for 5 years. When malignant ascites developed, treatment changed to carboplatin plus bevacizumab.

During the new admission, testing showed severe pulmonary hypertension without a conventional large pulmonary embolism. Her breathing and heart pressures worsened despite treatment directed at the pulmonary hypertension. After limited improvement, she chose to transition to comfort measures and died on hospital day 29.

Autopsy showed metastatic ovarian serous carcinoma with peritoneal and pleural tumor implants, bilateral pleural effusions, and tumor emboli in the pulmonary arteries. The cause of death was attributed to pulmonary hypertension from the metastatic ovarian cancer and pulmonary arterial tumor emboli. This rare complication, called pulmonary tumor thrombotic microangiopathy, can be difficult to diagnose while a patient is alive. Her cancer journey included surgery, long-term hormone therapy, later chemotherapy with bevacizumab, and ultimately comfort-focused care when the pulmonary complication progressed rapidly.