title: Systemic embolic events with nonbacterial thrombotic endocarditis as manifestations of recurrent ovarian clear cell carcinoma.
abstract: OBJECTIVE
  To present a rare case of recurrent ovarian clear cell carcinoma (OCCC) with systemic embolic events.
  
  
  METHODS
  A 60-year-old woman with a history of OCCC presented with an acute ischemic stroke. Magnetic resonance imaging showed multifocal, bilateral infarctions over the cerebrum and cerebellum. An echocardiogram revealed vegetation growth in the mitral and tricuspid valves and showed no evidence of atrial fibrillation. The serological studies for stroke were negative for all assessed parameters (normal values of protein C, protein S, antithrombin III, and lupus anticoagulant antibodies). Computed tomography of the abdomen and pelvis revealed bilateral renal and splenic infarctions, as well as enlarged pelvic lymph nodes due to a recurrent ovarian neoplasm. We diagnosed the patient with nonbacterial thrombotic endocarditis (NBTE) based on serial negative blood cultures and sterile vegetation of the surgical specimen.
  
  
  CONCLUSIONS
  NBTE should be considered among the possible causes of multifocal embolic infarctions and as an early manifestation of recurrent OCCC. Anticoagulant therapy is the mainstay of treatment, and dual anticoagulation therapies are necessary to reduce the risk of recurrent thromboembolism.
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yu-Kai
authors.initials: YK
authors.lastname: Lin
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Jiunn-Tay
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Fu-Chi
authors.initials: FC
authors.lastname: Yang
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yueh-Feng
authors.initials: YF
authors.lastname: Sung
authors.affiliation: Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Kao
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: yukai0907@ndmctsgh.edu.tw.
authors.forename: Chang-Hung
authors.initials: CH
authors.lastname: Hsu
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D004617:Embolism / Q000175:diagnosis / Q000209:etiology*; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009360:Neoplastic Cells, Circulating; D010051:Ovarian Neoplasms / Q000150:complications* / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
keywords: noninfective endocarditis; ovarian neoplasms; recurrence; stroke