To the Editor.—In the October 1988 issue of the Archives, Hirata and coworkers1 reported a case of cor pulmonale due to tumor cell microemboli from gastric carcinoma. Subacute cor pulmonale due to tumor embolization to the lungs is not as rare as the authors seemed to indicate. My colleagues and I, from The People's Republic of China, recently described 6 patients in addition to the 33 cases reported in the literature.2
As Hirata and coworkers1 pointed out, subacute cor pulmonale due to tumor cell microemboli to the lungs was often the initial manifestation of clinically occult malignancies.2 The most common origin of tumor emboli was the stomach, followed by the breast, choriocarcinoma, uterine cervix, prostate, lung, liver, esophagus, colon, and chordoma.2
Clinical awareness and correct antemortem diagnosis of this not uncommon clinicopathologic entity can beexpected to become increasingly important, as progress in chemotherapy of