Signet ring cell carcinoma metastasis in the bone marrow accompanied by cancer related thrombotic microangiopathy as a first presentation

Abstract

Cancer related thrombotic microangiopathies usually cause a diagnostic dilemma for hematologists and clinicians. In this case report, we presented a fifty-nine-year-old man who was admitted to our hospital with microangiopathic hemolytic anemia and thrombocytopenia due to the carcinoma metastasis to the bone marrow. As a result of rapid evaluations, it was revealed that the histological subtype of the cancer was signet ring cell carcinoma, and despite all the interventions, the patient died at a very short time after the initial presentation. Regardless of all the innovations in the diagnosis and treatment of thrombotic microangiopathies, cancer-associated thrombotic microangiopathy is still fatal and deadly today.

Cancer‐related thrombotic microangiopathy and disseminated intravascular coagulation in a patient with bone marrow carcinomatosis of unknown primary origin: A case report

“…In the present case, the patient's low‐risk PLASMIC score made a diagnosis of TTP unlikely; hence, we avoided PEX, which has no benefit for CR‐TMA. It has been reported that the PLASMIC score is useful for differential diagnosis and avoiding unnecessary PEX, such as in the present case 8 …”

“…It has been reported that the PLASMIC score is useful for differential diagnosis and avoiding unnecessary PEX, such as in the present case. 8 DIC is a form of MAHA that arises from abnormal activation of the coagulation cascade, leading to microvascular thrombosis, the consumption of endogenous anticoagulants, excessive generation of fibrin, and the development of fibrinolytic derangements. 9 Certain cancers are more likely to provoke DIC, particularly adenocarcinomas of the gastrointestinal tract (especially the signet-ring cell type), pancreas, breast, prostate, or lung, and mucinous tumors may secrete enzymes that can activate factor X.…”