title: Thrombotic thrombocytopenic purpura as the first manifestation of metastatic adenocarcinoma in a young woman.
abstract: Thrombotic microangiopathy occurs in 5-10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patient's refusal. Although chemotherapy including cis-platinum, infusional 5-fluorouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.
authors.affiliation: Adnan Menderes University Medical Faculty, Division of Hematology, 09100 Aydin, Turkey. gurhan@prontomail.com
authors.forename: Gurhan
authors.initials: G
authors.lastname: Kadikoylu
authors.forename: Sabri
authors.initials: S
authors.lastname: Barutca
authors.forename: Canten
authors.initials: C
authors.lastname: Tataroglu
authors.forename: Samet
authors.initials: S
authors.lastname: Kafkas
authors.forename: Hakan
authors.initials: H
authors.lastname: Erpek
authors.forename: Nezih
authors.initials: N
authors.lastname: Meydan
authors.forename: Irfan
authors.initials: I
authors.lastname: Yavasoglu
authors.forename: Zahit
authors.initials: Z
authors.lastname: Bolaman
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000097:blood / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D019046:Bone Marrow Neoplasms / Q000737:chemistry / Q000150:complications / Q000188:drug therapy / Q000556:secondary*; D018279:Carcinoma, Signet Ring Cell / Q000097:blood / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy / Q000556:secondary*; D002945:Cisplatin / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006465:Hemoperitoneum / Q000150:complications / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D002955:Leucovorin / Q000008:administration & dosage; D009382:Neoplasms, Unknown Primary / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D010051:Ovarian Neoplasms / Q000737:chemistry / Q000150:complications / Q000188:drug therapy / Q000556:secondary*; D010951:Plasma Exchange; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology
chemical_list: D014408:Biomarkers, Tumor; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil