Nonbacterial thrombotic endocarditis in cancer patients: Comparison of characteristics of patients with and without concomitant disseminated intravascular coagulation

Bedikian, Agop Y.; Valdivieso, Manuel; Luna, Mario A.; Bodey, Gerald P.

doi:10.1002/mpo.2950040211

Cited by 36 publications

(12 citation statements)

References 28 publications

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“…2,5 Adenocarcinomas of the lung and ovary comprise nearly 50% of the cases, followed by hematologic malignancies that account for 25%. [5][6][7][8] Therefore, when evaluating patients with NBTE without a clear etiology, an occult neoplasm must be excluded.…”

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confidence: 99%

Nonbacterial Thrombotic Endocarditis with Recurrent Embolic Events as Manifestation of Ovarian Neoplasm

2006

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We describe the case of a 43-year-old woman with transient ischemic neurologic deficits and recurrent systemic and pulmonary emboli in whom infectious work-up and extensive thrombophilic evaluation were unremarkable. Transesophageal echocardiography (TEE) established the diagnosis of nonbacterial thrombotic endocarditis (NBTE). This is a rare condition often associated with hypercoagulable states or advanced malignancy such as adenocarcinomas, characterized by cardiac vegetations along valvular coaptation lines without destruction of leaflets. In our patient, we diagnosed an ovarian clear cell adenocarcinoma, a malignant disorder that has been rarely reported in association with NBTE. This case illustrates that NBTE can present as an atypical manifestation of malignancy and must be distinguished from infective endocarditis, which implies a different therapeutic strategy. When confronted with findings of NBTE without a clear etiology, an occult neoplasm must be excluded. Anticoagulant therapy is the mainstay of treatment. However, cardiac vegetations may require surgical intervention in rare instances.

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confidence: 99%

Nonbacterial Thrombotic Endocarditis with Recurrent Embolic Events as Manifestation of Ovarian Neoplasm

2006

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“…Lastly, Sharma et al [33] described fatal cerebral embolization from NBTE in a patient with major trauma, adult respiratory distress syndrome, sepsis, and DIC. In a series of 31 patients with NBTE and cancer reported by Bedikian et al [1], there was a 64.5% incidence of pneumonia. The immediate cause of death was pneumonia in 34.5% of the cases, and chronic pulmonary failure in 12.9%.…”

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confidence: 96%

“…Kim et al [19] found histologic evidence of DIC in 50% of patients with NBTE in their autopsy series. Bedikian et al [1] found histologic evidence of DIC in 71% of their patients with NBTE and cancer. However, a prospective study of cancer patients by Edoute et al [9] found no statistically significant increase in the incidence of Ddimer elevation among patients with valvular vegetations compared with those without vegetations.…”

Section: Resultsmentioning

confidence: 97%

“…NBTE has been found in association with malignant tumors, especially adenocarcinomas [1,9,19,24], bone marrow transplantation [17,22,29], acquired immunodeficiency syndrome [4,15,18,31], snake bites [35], thrombotic thrombocytopenic purpura [36], certain autoimmune disorders [10,28], major trauma [33], and septicemia and burns [24]. In many cases, disseminated intravascular coagulation (DIC) was present in patients with NBTE [1,16,19,24].…”

Section: Introductionmentioning

confidence: 99%

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Association between nonbacterial thrombotic endocarditis and hypoxigenic pulmonary diseases

Truskinovsky

Hutchins

2001

Virchows Arch

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Observation of patients with nonbacterial thrombotic endocarditis (NBTE) in the setting of hypoxia from various lung diseases raised the question of a possible pathogenetic relationship between hypoxia and the development of NBTE. We reviewed 50 autopsied patients with NBTE and compared them with 50 age/race/gender-matched control patients without NBTE. We noted the lung weight and graded the histopathological severity of lung involvement by disease, clinical respiratory compromise, and the extent of any cancer present. Patients with NBTE had heavier lungs (P < 0.01) and histologically and clinically more severe pulmonary disease (both P < 0.005). There was no statistically significant difference in the extent of metastatic cancer between the NBTE patients and the controls (P > 0.5). When patients with cancer were excluded from the group of NBTE cases, there was still a statistically significant preponderance in the mean lung injury and clinical compromise scores of the NBTE patients (both P < 0.05), but the difference in lung weight was no longer statistically significant (P > 0.05). The study suggests that, in some patients, hypoxia may lead to NBTE, possibly through altered coagulation states.

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“…Among cancer patients, adenocarcinoma is by far the most common histological subtype. Some case series have also reported an association with hematologic malignancies, particularly leukemia [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Ovarian Clear Cell Carcinoma Presenting as Non-bacterial Thrombotic Endocarditis and Systemic Embolization

Oueida¹,

Scola

2011

World J Oncol

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Non-bacterial thrombotic endocarditis (NBTE) is a rare manifestation of cancer-induced hypercoaguability. It most commonly occurs in association with mucin-producing adenocarcinomas and has rarely been described with ovarian clear cell carcinoma (OCCC). We report a case of NBTE with multi-organ embolic infarcts occurring in a patient with early stage clear cell ovarian cancer. A 56 years old Caucasian female presented with leg pain, and left flank discomfort. Evaluation revealed multi-organ infarction, extensive deep vein thrombosis (DVT), and the incidental presence of an asymptomatic large ovarian mass with a laboratory picture consistent with disseminated intravascular coagulation (DIC). The diagnosis of NBTE was supported by echocardiogram and multiple negative bacteriological studies. She underwent surgical extirpation of an early stage OCCC and initiation of anticoagulation. Postoperatively, the patient’s hypercoaguability promptly resolved with gradual resolution of vegetations. Subsequent recurrence of the malignancy was heralded by a return of the prothrombotic state. This case shows a rarely reported association between NBTE and OCCC. It illustrates how the clinical picture of NBTE can dominate the initial presentation of an early stage and otherwise asymptomatic malignancy. Late recognition can lead to significant morbidity and a rapidly fatal course. Recurrent thromboembolism may be the first indication of disease recurrence.

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Nonbacterial thrombotic endocarditis in cancer patients: Comparison of characteristics of patients with and without concomitant disseminated intravascular coagulation

Cited by 36 publications

References 28 publications

Nonbacterial Thrombotic Endocarditis with Recurrent Embolic Events as Manifestation of Ovarian Neoplasm

Nonbacterial Thrombotic Endocarditis with Recurrent Embolic Events as Manifestation of Ovarian Neoplasm

Association between nonbacterial thrombotic endocarditis and hypoxigenic pulmonary diseases

Ovarian Clear Cell Carcinoma Presenting as Non-bacterial Thrombotic Endocarditis and Systemic Embolization

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