Ovarian cancer with initial symptom of pulmonary embolism: A case report

Abstract

Venous thromboembolism often occurs after major surgery and may occur as a consequence of underlying cancer. A 39-year-old woman presented to the emergency room with chief complaints of dyspnea and right chest pain. Chest computed tomography (CT) revealed pulmonary artery thromboembolism of the left lobe and a massive right pleural effusion. D-dimer level was 40.4 µg/mL. Abdomino-pelvic CT revealed a 15×12×14 cm solid and cystic mass in the pelvic cavity, suggesting ovarian cancer. A pleural biopsy found metastatic adenocarcinoma. She underwent cytoreductive surgery and pathologic findings revealed malignant mullerian mixed tumor of ovary. The hypercoagulable state in patients with ovarian cancer may occur as an initial symptom of pulmonary embolism. It is unresponsive to standard anticoagulation therapy. The hypercoagulable state in patient with ovarian cancer may be stopped by cytoreductive surgery of the malignancy. The association between venous thrombosis and malignancy was first described by Trousseau [1] in 1865 and this has been confirmed by several clinical, pathologic and laboratory studies. The thromboembolic event occurs before the diagnosis of cancer, and it has an increased risk of ovarian cancer during the first year of follow-up [2]. A previous report suggests that venous thromboembolism (VTE) may occur as a consequence of underlying cancer, and VTE can be detected prior to the diagnosis of cancer. Some authors estimate that as many as 15% of patients with ovarian cancer will have a thromboembolism [3]. A study on incidental pulmonary embolism (PE) in patients with cancer revealed that the highest prevalence occurred in patients with gynecologic malignancies [4]. We report a case of a 39-year-old patient with ovarian cancer and PE as the initial symptom. Keywords: Ovarian cancer; Pulmonary embolism; Venous thromboembolism Case ReportA 39-year-old woman presented to the emergency room with the chief complaints of dyspnea and right chest pain that had begun a few days earlier. She was healthy at birth and had no past history of underlying disease or clotting abnormality. There was no history of oral medication, pregnancy, or any other gynecological/surgical problem. On presentation, she was mild febrile, had tachycardia with a regular rate, and her lungs were clear on auscultation. Laboratory studies revealed a hemoglobin value of 10.9 g/dL; prothrombin time 16.5 sec (normal range [NR], 11.0 to 15.0 sec); partial thromboplastin time 45.0 sec (NR, 29.0 to 44.0 sec); Ddimer 40.4 µg/mL (NR<0.4 µg/mL); and C-reactive protein (CRP) 11.53 mg/dL (NR<0.3 mg/dL). Korean J Obstet Gynecol 2012;55(8):606-609 http://dx CASE REPORT