title: Microangiopathic hemolytic anemia as the first manifestation of metastatic signet ring cell carcinoma of unknown origin: a case report and review of literature.
abstract: Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.
authors.affiliation: Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Sang-Yong
authors.initials: SY
authors.lastname: Shin
authors.forename: Hyosoon
authors.initials: H
authors.lastname: Park
authors.forename: Seoung Wan
authors.initials: SW
authors.lastname: Chae
authors.forename: Hee-Yeon
authors.initials: HY
authors.lastname: Woo
mesh_terms: D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D019046:Bone Marrow Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D018279:Carcinoma, Signet Ring Cell / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D006242:Haptoglobins / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009336:Necrosis / Q000209:etiology; D009362:Neoplasm Metastasis; D049268:Positron-Emission Tomography; D011697:Purpura, Thrombotic Thrombocytopenic / Q000175:diagnosis* / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D006242:Haptoglobins