Systemic embolic events with nonbacterial thrombotic endocarditis as聽manifestations of recurrent ovarian clear cell carcinoma

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• 作者：Yu-Kai Lin^a ; Jiunn-Tay Lee^a ; Fu-Chi Yang^a ; Yueh-Feng Sung^a ; Hung-Wen Kao^b ; ^c ; Chun-Chieh Lin^a ; Chang-Hung Hsu^a ; ^{yukai0907@ndmctsgh.edu.tw" class="auth_mail" title="E-mail the corresponding author} ; ^{drshyu@seed.net.tw" class="auth_mail" title="E-mail the corresponding author}
• 关键词：noninfective endocarditis ; ovarian neoplasms ; recurrence ; stroke
• 刊名：Taiwanese Journal of Obstetrics and Gynecology
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：54
• 期：5
• 页码：625-628
• 全文大小：528 K

文摘

To present a rare case of recurrent ovarian clear cell carcinoma (OCCC) with systemic embolic events.

Case report

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.

Conclusion

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.