Lung histology from a case of pulmonary tumour thrombotic microangiopathy related to severe pulmonary hypertension. a) Post mortem section showing occlusion.

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Lung histology from a case of pulmonary tumour thrombotic microangiopathy related to severe pulmonary hypertension. a) Post mortem section showing occlusion of a medium-sized pulmonary arterial lumen by fibrointimal proliferation of fibroblasts and collagen... Lung histology from a case of pulmonary tumour thrombotic microangiopathy related to severe pulmonary hypertension. a) Post mortem section showing occlusion of a medium-sized pulmonary arterial lumen by fibrointimal proliferation of fibroblasts and collagen (white arrow) and tumour emboli (black arrow) (Haematoxylin and eosin stain ×4.3). Scale bar=500 μm. b) Post mortem section showing a medium-sized pulmonary artery with two elastic layers, with a normal-sized smooth muscle layer. There is exaggerated luminal occlusion by fibrointimal thickening (white arrow) surrounding nests of tumour emboli (black arrow). The adventitia contains lymphatic tumoral thrombi. Increased alveolar macrophages are seen surrounding the lung (Elastica van Gieson stain ×4.6). Scale bar=500 μm. c) Evidence for fibrointimal proliferation within the lumen of small pulmonary veins (black arrow) and tumour involvement of accompanying lymphatics (white arrow). Inset: veins close to the centrilobular bronchovascular bundles show eccentric fibrointimal remodelling (Elastica van Gieson ×28.4). Scale bar=80 μm. Reproduced from [26]. Laura C. Price et al. Eur Respir Rev 2019;28:180065 ©2019 by European Respiratory Society