Synchronous Ovarian and Endometrial Endometrioid Adenocarcinoma Presenting with Nonbacterial Thrombotic Endocarditis and Pulmonary Thromboembolism: Adenocarcinoma with Thrombotic Events

N K Erturk,D Basaran,A Erturk,N Ozgul

doi:10.1155/2015/825404

Abstract

Introduction. Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms. Case Report. A fifty-six-year-old woman presented to the emergency service; the clinical workup revealed deep vein thrombosis in right leg and bilateral massive PTE. As the abdominal sections on the spiral CT revealed a giant pelvic mass of ovarian origin, she was referred to our hospital's gynecologic oncology department. She was scheduled for surgery under enoxaparin. She described numbness on one side of her face. Cranial imaging findings revealed acute ischemic cerebral lesions and transesophageal echocardiogram showed vegetation on the aortic cusp. Under anticoagulation treatment, she underwent hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. After tumor resection, her neurological symptoms dissolved with aggressive anticoagulant treatment. Pathology result was synchronous endometrial and ovarian adenocarcinoma. Discussion. NBTE is a rare condition often associated with advanced malignancies. Peripheral embolism and venous thrombosis are complications that have been associated with NBTE due to hypercoagulable state. These disorders could be resistant to routine anticoagulant treatment. In case of a thrombotic complication due to ovarian malignancy, surgical resection of the primary tumor may increase the effect of anticoagulant treatment.

Highlights

Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms
Hypercoagulability of malignancy could represent a clinical spectrum ranging from abnormal coagulation tests, but no clinically evident thromboembolic disease, to arteriovenous thrombosis, migratory thrombophlebitis, nonbacterial thrombotic endocarditis, and disseminated intravascular coagulation [2]
Tumor-cell procoagulants, and increased levels of coagulation factors are the mechanisms of paraneoplastic hypercoagulability [6]

Summary

Introduction

Thrombosis is a common complication in cancer patients, with 15% of all cancer patients developing clinically apparent thrombosis [1]. Systemic coagulopathy underlies the thrombosis in patients with malignant disease. Hypercoagulability of malignancy could represent a clinical spectrum ranging from abnormal coagulation tests, but no clinically evident thromboembolic disease, to arteriovenous thrombosis, migratory thrombophlebitis, nonbacterial thrombotic endocarditis, and disseminated intravascular coagulation [2]. Nonbacterial thrombotic endocarditis (NBTE) is a rare manifestation of hypercoagulability in patients with malignant neoplasms. Peripheral embolism and venous thromboses are complications that have been associated with NBTE due to a hypercoagulable state [3]. Systemic embolization to multiple organs is common, with embolization to brain ranging from 14 to 91% [4]. We report a rare association of NBTE in a patient with two primary gynecological cancers presenting with embolic stroke and pulmonary thromboembolism (PTE). To the best of our knowledge, such a case has never been reported in the literature

Case Report

Findings

Discussion