Thrombotic thrombocytopenic purpura as the first manifestation of metastatic adenocarcinoma in a young woman.
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.
Kadikoylu
Gurhan
G
Adnan Menderes University Medical Faculty, Division of Hematology, 09100 Aydin, Turkey. gurhan@prontomail.com
Barutca
Sabri
S
Tataroglu
Canten
C
Kafkas
Samet
S
Erpek
Hakan
H
Meydan
Nezih
N
Yavasoglu
Irfan
I
Bolaman
Zahit
Z
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
D014408:Biomarkers, Tumor; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil