Nonbacterial thrombotic endocarditis complicated with stage Ia ovarian cancer

Abstract

Nonbacterial thrombotic endocarditis (NBTE) commonly occurs in advanced malignancies associated with a cancer-related hypercoagulable state, but the prevalence of NBTE in patients with less advanced malignancies is unknown. A 46-year-old woman had multiple thromboembolic events and disseminated intravascular coagulation on admission. Transthoracic echocardiography showed several growths on the mitral valve. Pelvic magnetic resonance imaging revealed a rapidly enlarging large tumor. In spite of anticoagulation therapy, she died 1.5 months after admission. At autopsy, NBTE with stage Ia ovarian cancer was diagnosed. In cases of higher-growth rate tumors with abundant necrosis, NBTE may occur in early-stage (even in stage Ia) ovarian cancer. In the majority of stage Ia ovarian cancers, curative surgical resection can be done. Prognostic improvement may be gained by such positive intervention, although this depends on the patient's general condition when NBTE occurs. With tumor resection, there is a possibility that the patient will recover from the hypercoagulable state and a poor outcome will be avoided.

Endocarditis marántica como presentación de cáncer de páncreas. Caso clínico

“…En cuanto al pronóstico, éste varía en relación a la efectividad del tratamiento de la neoplasia primaria. En estudios en cáncer de ovario, una intervención quirúrgica positiva puede influir en gran medida, aunque esto depende de la condición general del paciente cuando se produce la endocarditis marántica 14 . En la mayoría de los casos, la muerte se produjo a consecuencia de la principal enfermedad asociada, 32% causa neoplásica, en cambio sólo 9,1% de los casos la causa de la muerte está directamente relacionada con la presencia de endocarditis marántica.…”

Non‐bacterial thrombotic endocarditis with systemic embolic events caused by adenomyosis

“…In conclusion, the present case illustrates that a hypercoagulative state can be induced by reactive changes and glandular hemorrhage of adenomyosis. Not only advanced malignancy but also early‐stage neoplasm 1 and benign condition can cause NBTE. That is, whether malignant or benign, hypercoagulable states are responsible for NBTE.…”

“…4 The great majority of underlying gynecological neoplasms associated with NBTE are ovarian carcinomas. 1,5,6 A MEDLINE search revealed no reports of NBTE associated with benign gynecological tumors and few reports of DIC associated with such tumors (reported cases were of adenomyosis 7 and uterine myoma). 8 Nakamura reported that DIC developed during menstruation in a patient with adenomyosis and postulated that damage to the myometrium and endometrial glands in adenomyosis produced microthrombosis and tissue factors, triggering the coagulation pathway.…”

“…Non‐bacterial thrombotic endocarditis (NBTE) is a rare condition and is usually associated with advanced malignancy and hypercoagulable states. The great majority of underlying gynecological neoplasms associated with NBTE are ovarian carcinomas; 1,2,3 the literature contains no reports of this type of endocarditis associated with benign tumors. Adenomyosis is a benign gynecological condition in which endometrial glands and stroma become ectopically located within the myometrium and undergo inflammatory and reactive changes.…”

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

“…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 ].…”