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

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.

Nonbacterial thrombotic endocarditis: A rare manifestation of gynecologic cancer

“…In that case, despite resolution of NBTE on warfarin, the patient's prognosis was very poor due to metastatic disease. Another recently published case report with synchronous ovarian and endometrial cancer describes a patient with massive pulmonary embolism who subsequently experienced neurological manifestations prompting workup that revealed acute ischemic cerebral lesions and NBTE ( Erturk et al, 2015 ). Finally, isolated cases of ovarian cancer complicated by NBTE with disseminated intravascular coagulation have also been described in literature ( Tanaka et al, 2009 ).…”

Quadrivalvular non-bacterial thrombotic endocarditis in a patient with clear cell cervical cancer

“…Whereas venous thromboembolism (VTE) is a frequent clinical event in patients with cervical cancer [1], nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, has rarely been described associated to gynecological malignancy [2] and in most of the cases, the diagnosis was confirmed postmortem [3,4]. NBTE is considered as a manifestation of an overall prothrombotic state [5] characterized by valve associated masses consisting of platelets and fibrin in absence of bacteria and without inflammatory destruction of the heart valves.…”

Quadrivalvular nonbacterial thrombotic endocarditis in a patient with clear cell cervical cancer

“…Whereas venous thromboembolism (VTE) is a frequent clinical event in patients with cervical cancer, 1 nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, has rarely been described associated with gynecological malignancy 2 and, in most of the cases, the diagnosis was confirmed postmortem. 3 , 4 NBTE is considered as a manifestation of an overall prothrombotic state 5 characterized by valve associated masses consisting of platelets and fibrin in absence of bacteria and without inflammatory destruction of the heart valves.…”

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Whereas venous thromboembolism (VTE) is a frequent clinical event in patients with cervical cancer, 1 nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, has rarely been described associated with gynecological malignancy 2 and, in most of the cases, the diagnosis was confirmed postmortem. 3,4 NBTE is considered as a manifestation of an overall prothrombotic state 5 characterized by valve associated masses consisting of platelets and fibrin in absence of bacteria and without inflammatory destruction of the heart valves.We report a case of NBTE of all heart valves and the atrial septum in a patient suffering from clear cell cervical cancer resulting in fatal venous and arterial thromboembolic events.

| CASE REPORTA 52-year-old female patient was referred to our university medical center with suspected acute infectious endocarditis (IE). Nine days before, an ischemic stroke of the left middle cerebral artery had been diagnosed at the

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