title: Massive hypercoagulable state despite full-dose anticoagulant treatment in a patient with occult malignancy: considerations concerning chemotherapy without definitive diagnosis.
abstract: A 55-year-old female patient presented with recurrent deep venous thrombosis and pulmonary embolism while on oral anticoagulant treatment using the vitamin K antagonist phenprocoumon. Hypercoagulable state was regarded to be paraneoplastic, but no underlying malignancy could be identified despite extensive screening for cancer, including gastroscopy and colonoscopy, a bone marrow biopsy, thoracoabdominal CT scans with subsequent biopsies of possibly malignant findings, octreotide scintigraphy, skeletal scintigraphy and gynaecological screening. In the course of her hospital stay she developed progressive right cardiac insufficiency due to the formation of new thromboses despite aggressive anticoagulant treatment and died of right-sided heart failure. The autopsy showed a poorly differentiated adenocarcinoma in the middle lobe of the right lung. In addition, pulmonary lymphangiosis carcinomatosa, pleural and pericardial carcinosis, and lymph node metastases and osteoblastic vertebral body metastases were shown.
authors: Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany. kathrin.ehren@ukb.uni-bonn.de
authors: Kathrin
authors: K
authors: Ehren
authors: Christof
authors: C
authors: Lamberti
authors: Bernd
authors: B
authors: Poetzsch
authors: Michael
authors: M
authors: Majores
authors: Katharina
authors: K
authors: Strach
authors: Tilman
authors: T
authors: Sauerbruch
authors: Jan-Christian
authors: JC
authors: Wasmuth
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000473:pathology; D000925:Anticoagulants / Q000627:therapeutic use*; D001344:Autopsy; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006338:Heart Neoplasms / Q000556:secondary; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000556:secondary; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology; D013125:Spinal Neoplasms / Q000556:secondary; D020246:Venous Thrombosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants