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Rani S, Lai A, Nair S, Sharma S, Handberg A, Carrion F, Möller A, Salomon C. Extracellular vesicles as mediators of cell-cell communication in ovarian cancer and beyond - A lipids focus. Cytokine Growth Factor Rev 2023; 73:52-68. [PMID: 37423866 DOI: 10.1016/j.cytogfr.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 07/11/2023]
Abstract
Extracellular vesicles (EVs) are messengers that carry information in the form of proteins, lipids, and nucleic acids and are not only essential for intercellular communication but also play a critical role in the progression of various pathologies, including ovarian cancer. There has been recent substantial research characterising EV cargo, specifically, the lipid profile of EVs. Lipids are involved in formation and cargo sorting of EVs, their release and cellular uptake. Numerous lipidomic studies demonstrated the enrichment of specific classes of lipids in EVs derived from cancer cells suggesting that the EV associated lipids can potentially be employed as minimally invasive biomarkers for early diagnosis of various malignancies, including ovarian cancer. In this review, we aim to provide a general overview of the heterogeneity of EV, biogenesis, their lipid content, and function in cancer progression focussing on ovarian cancer.
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Affiliation(s)
- Shikha Rani
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Andrew Lai
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Soumya Nair
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Shayna Sharma
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD 4029, Australia
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Flavio Carrion
- Departamento de Investigación, Postgrado y Educación Continua (DIPEC), Facultad de Ciencias de la Salud, Universidad del Alba, Santiago, Chile
| | - Andreas Möller
- Department of Otorhinolaryngology, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carlos Salomon
- Translational Extracellular Vesicles in Obstetrics and Gynae-Oncology Group, University of Queensland Centre for Clinical Research, Faculty of Medicine, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD 4029, Australia; Departamento de Investigación, Postgrado y Educación Continua (DIPEC), Facultad de Ciencias de la Salud, Universidad del Alba, Santiago, Chile.
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Tandi R, Bansal S, Sahu S, Dinesh Eshwar M, Raghavan P, Kulkarni OV, Natarajan B, Dodda S, Banur A. Stroke as a Paraneoplastic Manifestation of Ovarian Cancer: A Case Report. Cureus 2022; 14:e29835. [PMID: 36337801 PMCID: PMC9625077 DOI: 10.7759/cureus.29835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
People with gynecologic neoplasms have the highest risk of having an ischemic stroke. A 76-year-old woman came into the stroke unit of our hospital complaining of anosmia and acutely developing dysarthria. She was ultimately determined to have ovarian cancer after extensive testing. Ovarian carcinoma is one of the neoplasms that cause ischemic stroke and is most commonly documented in case studies. Identifying the underlying neoplastic condition in female ischemic stroke patients who are otherwise "healthy" is crucial as an early surgical intervention on cancer offers therapeutic treatment for both malignancy and thromboembolism.
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3
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Elmehrath AO, Afifi AM, Abdel-Malek R. Non-cancer death causes after ovarian cancer diagnosis: A population-based cohort. J Obstet Gynaecol Res 2021; 47:1884-1891. [PMID: 33751749 DOI: 10.1111/jog.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/01/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research on non-cancer death causes in ovarian cancer (OC) patients remains limited. We aim to focus on and evaluate the non-cancer death causes after OC diagnosis. METHODS We studied 82 590 OC patients diagnosed between 2000 and 2016, using the Surveillance, Epidemiology, and End Results (SEER) Program. Risks of death causes were calculated as standardized mortality ratios. RESULTS Of included patients, 48 125 (58.3%) died during the follow-up period. The highest number of deaths, 21 722 (45.1%), occurred within 1-5 years after OC diagnosis. On the other hand, 19 992 (41.5%) of deaths occurred within a year from ovary cancer diagnosis, 5255 (10.9%) occurred within 5-10 years, and 1156 (2.4%) deaths occurred after more than 10 years following OC diagnosis. Non-cancer death causes comprise a significant percentage of deaths in OC patients, increasing with time after diagnosis. CONCLUSIONS Cardiac diseases, cerebrovascular diseases, and COPD were among the most common non-cancer death causes after OC diagnosis. Other critical non-cancer death causes include septicemia and benign neoplasms. Mortality risk differences based on race and age were also highlighted. These findings provide critical insights into how OC survivors should be followed-up and counseled for relevant future health risks.
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Affiliation(s)
| | - Ahmed M Afifi
- Department of Internal Medicine, Division of Digestive Diseases, University of Kentucky College of Medicine, Lexington, Kentucky, USA.,Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Raafat Abdel-Malek
- Clinical Oncology Department, Faculty of Medicine, Cairo University, Giza, Egypt.,Clinical Oncology Department, North West Cancer Center, Londonderry, UK
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Holt JN. A case of multifocal stroke-the first presentation of underlying ovarian malignancy. J Surg Case Rep 2021; 2021:rjaa550. [PMID: 33569161 PMCID: PMC7852472 DOI: 10.1093/jscr/rjaa550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 11/23/2022] Open
Abstract
Ischaemic stroke is a rare manifestation of hypercoagulability induced by underlying malignancy. It is proposed that paraneoplastic non-bacterial thrombotic endocarditis (NBTE) is the most common cause, predisposing to the formation of friable valvular lesions composed of platelets and fibrin that embolize commonly. Pancreas, gallbladder, stomach, colon and gynaecological malignancies have all been associated with NBTE. We describe a female patient who presented to our facility with syncope and limb weakness. Magnetic resonance imaging of the brain revealed ischaemic strokes in both the anterior and posterior circulation. Further investigation revealed a pelvic mass that was biopsy proven to be ovarian malignancy. Prognosis is heavily reliant on disease stage, thus diagnostic clues suggesting the possibility of underlying malignancy in the presentation of stroke should prompt a thorough investigation to exclude malignancy.
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Affiliation(s)
- Jonathon N Holt
- General Surgical Department, Albury-Wodonga Health, Albury, NSW, Australia
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Chi X, Zhao R, Pei H, Xing A, Hu S, Chen J, Mao Y, Zheng X. Diffusion-weighted imaging-documented bilateral small embolic stroke involving multiple vascular territories may indicate occult cancer: A retrospective case series and a brief review of the literature. Aging Med (Milton) 2020; 3:53-59. [PMID: 32232193 PMCID: PMC7099753 DOI: 10.1002/agm2.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 01/28/2023] Open
Abstract
Diffusion-weighted imaging (DWI) MRI is very sensitive for detecting small embolic brain infarctions. Stroke as the first manifestation of cancer is extremely rare. We performed a retrospective study to identify the clinical and DWI features of patients with acute ischemic stroke as the first manifestation of occult cancer. A total of five patients in our hospital from January 2017 to May 2019 were analyzed. We also reviewed the literature and seven case series (16 patients) were included. Most of these patients were aged in their sixties and lung cancer was the most common type of occult cancer. Patients showed various presentations of ischemic stroke. All of the patients showed small multiple lesions on DWI that involved mostly the anterior or both anterior and posterior territories. The lesions were mostly in both the supratentorium and infratentorium, with the mechanisms of embolic and watershed infarcts. These features were useful for identifying the causes of embolic stroke. Therefore, patients with small bilateral embolic stroke, especially those involved in multiple vascular territories, should be examined for concealed malignancy.
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Affiliation(s)
- Xiaosa Chi
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Renliang Zhao
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Haitao Pei
- Department of NeurologyAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Ang Xing
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Song Hu
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Jingjiao Chen
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Yongjun Mao
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xueping Zheng
- Department of GeriatricsAffiliated Hospital of Qingdao UniversityQingdaoChina
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6
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Predictors of unknown cancer in patients with ischemic stroke. J Neurooncol 2018; 137:551-557. [DOI: 10.1007/s11060-017-2741-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023]
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7
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Braicu EI, Darb-Esfahani S, Schmitt WD, Koistinen KM, Heiskanen L, Pöhö P, Budczies J, Kuhberg M, Dietel M, Frezza C, Denkert C, Sehouli J, Hilvo M. High-grade ovarian serous carcinoma patients exhibit profound alterations in lipid metabolism. Oncotarget 2017; 8:102912-102922. [PMID: 29262533 PMCID: PMC5732699 DOI: 10.18632/oncotarget.22076] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/11/2017] [Indexed: 11/25/2022] Open
Abstract
Ovarian cancer is a very severe type of disease with poor prognosis. Treatment of ovarian cancer is challenging because of the lack of tests for early detection and effective therapeutic targets. Thus, new biomarkers are needed for both diagnostics and better understanding of the cellular processes of the disease. Small molecules, consisting of metabolites or lipids, have shown emerging potential for ovarian cancer diagnostics. Here we performed comprehensive lipidomic profiling of serum and tumor tissue samples from high-grade serous ovarian cancer patients to find lipids that were altered due to cancer and also associated with progression of the disease. Ovarian cancer patients exhibited an overall reduction of most lipid classes in their serum as compared to a control group. Despite the overall reduction, there were also specific lipids showing elevation, and especially alterations in ceramide and triacylglycerol lipid species were dependent on their fatty acyl side chain composition. Several lipids showed progressive alterations in patients with more advanced disease and poorer overall survival, and outperformed CA-125 as prognostic markers. The abundance of many serum lipids correlated with their abundance in tumor tissue samples. Furthermore, we found a negative correlation of serum lipids with 3-hydroxybutyric acid, suggesting an association between decreased lipid levels and fatty acid oxidation. In conclusion, here we present a comprehensive analysis of lipid metabolism alterations in ovarian cancer patients, with clinical implications.
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Affiliation(s)
- Elena Ioana Braicu
- Department of Gynecology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- On Behalf of the Tumor Bank Ovarian Cancer Network, Berlin, Germany
| | - Silvia Darb-Esfahani
- On Behalf of the Tumor Bank Ovarian Cancer Network, Berlin, Germany
- Institute of Pathology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Tumor bank Ovarian Cancer Network, Berlin, Germany
| | - Wolfgang D. Schmitt
- Institute of Pathology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Tumor bank Ovarian Cancer Network, Berlin, Germany
| | | | | | - Päivi Pöhö
- VTT Technical Research Centre of Finland, Espoo, Finland
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jan Budczies
- Institute of Pathology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Tumor bank Ovarian Cancer Network, Berlin, Germany
| | - Marc Kuhberg
- Department of Gynecology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Manfred Dietel
- Institute of Pathology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Tumor bank Ovarian Cancer Network, Berlin, Germany
| | - Christian Frezza
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK
| | - Carsten Denkert
- Institute of Pathology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Tumor bank Ovarian Cancer Network, Berlin, Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- On Behalf of the Tumor Bank Ovarian Cancer Network, Berlin, Germany
| | - Mika Hilvo
- Zora Biosciences Oy, Espoo, Finland
- VTT Technical Research Centre of Finland, Espoo, Finland
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Xie X, Chen L, Zeng J, Qin C, Cheng D, Wei X, Liang Z. Clinical features and biological markers of lung cancer-associated stroke. J Int Med Res 2016; 44:1483-1491. [PMID: 28322105 PMCID: PMC5536770 DOI: 10.1177/0300060516666398] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective To identify the unique clinical features and biological markers of lung cancer-associated stroke. Methods We recruited 102 patients with lung cancer plus stroke, 102 with lung cancer, and 102 with stroke. Detailed information was analysed and compared among groups. Results The groups were age-matched. Patients with lung cancer plus stroke showed multiple lesions involving multiple cerebral artery territories on magnetic resonance imaging, compared with stroke-alone patients. These patients also had a poorer modified Rankin Scale score at 30 days, and high mortality (18.6%). Patients with lung cancer plus stroke had a higher incidence of metastasis, and higher blood levels of D-dimer, CA125 and CA199 compared with patients with lung cancer alone. Multivariate logistic regression analysis showed that levels of D-dimer, CA125 and CA199 were independently related to lung cancer-associated stroke. Conclusion Elevated plasma D-dimer, CA125 and CA199 may be independent risk factors for and biomarkers of lung cancer-associated stroke.
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Affiliation(s)
- Xingrui Xie
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Chen
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinsheng Zeng
- 2 Department of Neurology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chao Qin
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Daobin Cheng
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xinxian Wei
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhijian Liang
- 1 Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Selvik HA, Thomassen L, Bjerkreim AT, Næss H. Cancer-Associated Stroke: The Bergen NORSTROKE Study. Cerebrovasc Dis Extra 2015; 5:107-13. [PMID: 26648966 PMCID: PMC4662340 DOI: 10.1159/000440730] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/14/2015] [Indexed: 12/15/2022] Open
Abstract
Background Underlying malignancy can cause ischemic stroke in some patients. Mechanisms include the affection of the coagulation cascade, tumor mucin secretion, infections and nonbacterial endocarditis. The release of necrotizing factor and interleukins may cause inflammation of the endothelial lining, creating a prothrombotic surface that triggers thromboembolic events, including stroke. The aims of this study were to assess the occurrence of cancer in patients who had recently suffered an ischemic stroke and to detect possible associations between stroke and cancer subtypes. Methods All ischemic stroke patients registered in the Norwegian Stroke Research Registry (NORSTROKE) as part of the ongoing Bergen NORSTROKE study were included. Blood samples were obtained on admission. Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria, and the severity of stroke was defined according to the National Institute of Health Stroke Scale score. Information about cancer disease after stroke was obtained from patient medical records and The Cancer Registry of Norway. Results From a total of 1,282 ischemic stroke patients with no history of cancer, 55 (4.3%) patients were diagnosed with cancer after stroke. The median time from stroke onset to cancer diagnosis was 14.0 months (interquartile range 6.2-24.5). Twenty-three (41.8%) patients were diagnosed with cancer within 1 year and 13 (23.6%) within 6 months. The most common cancer type was lung cancer (19.0%). By Cox regression analysis, cancer after stroke was associated with elevated D-dimer levels on admittance (p < 0.001), age (p = 0.01) and smoking (p = 0.04). Conclusions Cancer-associated stroke is rare, and routine investigation for cancer seems unwarranted in acute ischemic stroke. However, in stroke patients with elevated levels of blood coagulation factors, C-reactive protein, higher age and a history of smoking, underlying malignancy should be considered. Our study suggests that an unknown stroke etiology does not predict malignancy.
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Affiliation(s)
- Henriette Aurora Selvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway ; Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Lars Thomassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway ; Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anna Therese Bjerkreim
- Department of Clinical Medicine, University of Bergen, Bergen, Norway ; Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Næss
- Department of Clinical Medicine, University of Bergen, Bergen, Norway ; Department of Neurology, Haukeland University Hospital, Bergen, Norway ; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Bond LM, Skrobo D. Multiple embolic cerebral infarcts as the first manifestation of metastatic ovarian cancer. BMJ Case Rep 2015; 2015:bcr-2015-211521. [PMID: 26443095 DOI: 10.1136/bcr-2015-211521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old woman presented to the emergency department with a 3-day history of an occipital headache associated with transient visual impairment and short-term memory loss. MRI of the brain showed innumerable focal embolic infarcts of differing ages, for which a cause could not be determined. The patient was discharged and readmitted 7 weeks later with acute aphasia and a right-sided hemiplegia. CT of the abdomen revealed a right-sided ovarian mass and prominent retroperitoneal nodes, which cytology confirmed to be metastatic ovarian cancer.
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Affiliation(s)
- Laura M Bond
- Department of Acute Medicine, Institution of Medicine, Dublin, Ireland
| | - Darko Skrobo
- Department of Acute Medicine, Institution of Medicine, Dublin, Ireland
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Kuan AS, Teng CJ, Wu HH, Su VYF, Chen YT, Chien SH, Yeh CM, Hu LY, Chen TJ, Tzeng CH, Liu CJ. Risk of ischemic stroke in patients with ovarian cancer: a nationwide population-based study. BMC Med 2014; 12:53. [PMID: 24661584 PMCID: PMC4022213 DOI: 10.1186/1741-7015-12-53] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/25/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors. METHODS Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test. RESULTS Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens. CONCLUSIONS Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chia-Jen Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Goedee S, Naber A, Rovers JMP, Roks G. Ischaemic stroke as initial presentation of systemic malignancy. BMJ Case Rep 2014; 2014:bcr-2013-202122. [PMID: 24591382 DOI: 10.1136/bcr-2013-202122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ischaemic stroke as the initial presentation of systemic malignancy is reported infrequently and is characterised by ischaemic lesions that exceed the vascular territory of a single vessel. There is also a high rate of early stroke recurrence. Several pathophysiological mechanisms are known to cause cerebrovascular complications in malignancies, as a direct effect of the tumour, paraneoplastic or even of the tumour treatment itself. Prognosis is reportedly poor, treatment is symptomatic and at best anecdotal. We present a case report and available literature.
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Affiliation(s)
- Stephan Goedee
- Department of Neurology, UMC Utrecht, Utrecht, The Netherlands
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Predictive value of plasma (D)-dimer levels for cancer-related stroke: a 3-year retrospective study. J Stroke Cerebrovasc Dis 2013; 23:e249-54. [PMID: 24295603 DOI: 10.1016/j.jstrokecerebrovasdis.2013.10.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Cerebrovascular disease is the second leading cause of central nervous system pathology in cancer patients. Cancer-associated hypercoagulation plays an important role in cancer-related stroke. The present study aims to test whether plasma d-dimer levels could predict comorbid malignancy in patients with ischemic stroke. METHODS Five hundred sixteen stroke patients with measured d-dimer levels and who were consecutively admitted to our stroke center from 2009 to 2012 were included. Cancer status was determined by medical chart, and 59 patients were identified to have active cancer. An additional 48 cancer patients with stroke were identified from the hospital database. Several d-dimer cutoff levels were used to predict cancer-related stroke. RESULTS Stroke patients with active cancer had significantly higher d-dimer levels than those without cancer (P < .001). The average d-dimer level in stroke patients without cancer was .66 ± 1.83 mg/L, whereas the levels for active cancer patients from the stroke center and hospital database were 5.70 ± 9.63 mg/L and 10.47 ± 12.31 mg/L, respectively. When using d-dimer of .55 mg/L or more and multiple territory infarctions as criteria, the specificity and positive predictive value (PPV) for cancer-related stroke were 99.7% and 92.9%, respectively. When using d-dimer of 5.5 mg/L or more as the cutoff value, the test had a high specificity and PPV regardless the brain magnetic resonance imaging (MRI) findings. Six stroke patients fitting our criteria were confirmed to have occult malignancy after comprehensive cancer survey. CONCLUSIONS Extraordinary high d-dimer levels or combining d-dimer and MRI findings may be used as a screening tool to detect malignancy in stroke patients.
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Tadokoro Y, Sakaguchi M, Yagita Y, Furukado S, Okazaki S, Fujinaka T, Kimura T, Yoshimine T, Mochizuki H, Kitagawa K. Ischemic stroke in patients with solid gynecologic tract tumors and coagulopathy. Eur Neurol 2013; 70:304-7. [PMID: 24080953 DOI: 10.1159/000353799] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 06/16/2013] [Indexed: 11/19/2022]
Abstract
AIM Patients with gynecological neoplasms often suffer ischemic stroke. This study aimed to clarify the underlying mechanisms of ischemic stroke in patients with gynecological tract tumors. METHODS We retrospectively reviewed 6 patients with gynecologic tumors and hypercoagulability who were being treated for acute ischemic stroke between 2006 and 2012. Diffusion-weighted magnetic resonance imaging (DW-MRI), cardiovascular risk factors including plasma D-dimer levels, and histologic examination of the patients' solid tumors were performed. All 6 patients underwent transesophageal echocardiography (TEE) for nonbacterial thrombotic endocarditis (NBTE) and paradoxical embolism. RESULTS All 6 patients showed elevated plasma D-dimer levels. In 1 patient, paradoxical embolism was diagnosed. In the remaining 5 patients, DW-MRI scans showed numerous lesions in multiple vascular territories, and in 4 of these 5 patients, TEE demonstrated vegetations on the mitral valve, leading to the diagnosis of NBTE. Interestingly, 2 of these 4 patients had benign uterine tumors, whereas the other 2 had ovarian cancer. CONCLUSIONS NBTE was the main etiology for ischemic stroke in patients with gynecologic tract tumors and coagulopathy. Both malignant and benign tumors of the gynecologic tract can cause NBTE.
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Affiliation(s)
- Yasuhiro Tadokoro
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
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Naoi H, Hashimoto H, Kajimoto E, Takeda M, Yoshida S, Miyatake T, Yokoi T, Isaka S, Nagamatsu M. Cerebral infarctions as manifestation of ovarian clear cell carcinoma: report of two cases and review of the literature. Int Cancer Conf J 2013. [DOI: 10.1007/s13691-013-0092-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Álvarez-Pérez F, Verde I, Usón-Martín M, Figuerola-Roig A, Ballabriga-Planas J, Espino-Ibañez A. Frequency and Mechanism of Ischemic Stroke Associated with Malignancy: A Retrospective Series. Eur Neurol 2012; 68:209-13. [DOI: 10.1159/000341343] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 06/24/2012] [Indexed: 11/19/2022]
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17
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Mitic N, Jankovic M. Activity profile of the CA125 antigen towards human red blood cells. ARCH BIOL SCI 2010. [DOI: 10.2298/abs1002271m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Starting from the mucin nature of the CA125 antigen and conditions associated with high serum concentrations, this study is an attempt to gain insight into its activity profile towards human erythrocytes. Carcinomaassociated and pregnancy-associated CA125 antigens were tested in agglutination/aggregation, adhesion and hemolysis assays. The results obtained indicated that CA125 antigens increased agglutination/aggregation and inhibited erythrocyte adhesion, but differed in their effective concentrations. Galectin-1 slightly modulated the effects observed. CA125 antigens had no effect on hemolysis. The activity profile of the CA125 antigen towards erythrocytes may have biomedical consequences in different microenvironments in relevant physiological and pathophysiological conditions.
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Affiliation(s)
- N. Mitic
- Department for Immunochemistry and Glycobiology, Institute for the Application of Nuclear Energy-INEP, Belgrade
| | - Miroslava Jankovic
- Department for Immunochemistry and Glycobiology, Institute for the Application of Nuclear Energy-INEP, Belgrade
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18
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Jameson GS, Ramanathan RK, Borad MJ, Downhour M, Korn R, Von Hoff D. Marantic Endocarditis Associated with Pancreatic Cancer: A Case Series. Case Rep Gastroenterol 2009; 3:67-71. [PMID: 20651968 PMCID: PMC2895179 DOI: 10.1159/000207195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Marantic endocarditis, otherwise known as nonbacterial thrombotic endocarditis (NBTE), is a well-documented phenomenon due to hypercoagulability from an underlying cause. It has been associated with a variety of inflammatory states including malignancy. Surprisingly, although hypercoagulability is often seen in patients with pancreatic cancer, marantic endocarditis has rarely been reported antemortem in this population. We report three cases of marantic endocarditis in patients with advanced pancreatic cancer. In two instances, the patients' neurological symptoms preceded the diagnosis of advanced pancreatic cancer. Health care professionals should be alert to the possibility of marantic endocarditis in any patient with cancer, especially pancreatic cancer, who presents with symptoms of neurological dysfunction or an arterial thrombotic event. Prompt diagnosis and treatment with heparin, unfractionated or low molecular weight, may prevent catastrophic CNS events and decrease morbidity in patients with pancreatic cancer and other malignancies.
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Affiliation(s)
- Gayle S Jameson
- Scottsdale Clinical Research Institute, TGen Clinical Research Services, Ariz., USA
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19
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Taccone FS, Jeangette SM, Blecic SA. First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis 2008; 17:169-74. [PMID: 18589335 DOI: 10.1016/j.jstrokecerebrovasdis.2008.01.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2007] [Accepted: 01/16/2008] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is a frequent complication in patients with cancer, occurring in nearly 15% of patients with cancer. However, cerebrovascular disease as the first manifestation of cancer has rarely been reported. METHODS We retrospectively reviewed all 5106 patients admitted for ischemic stroke to our stroke department between 1991 to 2004, and identified a group of 24 patients (0.4%) who had an underlying malignancy. RESULTS The mean age of the 24 patients was 52 +/- 4.1 years and 62.5% were women. Vascular risk factors were found in only 41% of patients. The principal mechanisms of stroke pathogenesis were nonbacterial thrombotic endocarditis (8/24), diffuse intravascular coagulation (6/24), and atherosclerosis (5/24). The most frequent neoplasms were lung and breast cancer. All patients but 4 were diagnosed with an underlying malignancy at the second ischemic event. Mean follow-up of surviving patients was 29 months (3-60). Nineteen patients died (79%), with a median survival of 58 days after cerebral infarction. CONCLUSIONS A systemic cancer workup should be considered in patients in whom stroke origin is unclear or who have an early vascular recurrence. Stroke as the first manifestation of an underlying malignancy is mostly secondary to specific cancer-related causes. Outcome is poor and correlates with both severity of neurologic disability and the stage of tumor.
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Affiliation(s)
- Fabio Silvio Taccone
- Neurology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
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Del Pace S, Alderighi C, Rasoini R, Alterini R, Micheli S, Santoro G. A 48-year-old woman with dyspnoea on exertion, anemia and thrombocytopenia. Intern Emerg Med 2008; 3:33-6. [PMID: 18324360 DOI: 10.1007/s11739-008-0138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
Affiliation(s)
- Stefano Del Pace
- Clinica Medica Generale e Cardiologia, Department of Heart and Vessels, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Viale Morgagni 85, 50134 Florence, Italy
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Navi BB, DeAngelis LM, Segal AZ. Multifocal strokes as the presentation of occult lung cancer. J Neurooncol 2007; 85:307-9. [PMID: 17611718 DOI: 10.1007/s11060-007-9419-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Abstract
Cancer patients are hypercoagulable through a variety of mechanisms and are at significant risk for ischemic stroke. Though usually occurring in the later stages of neoplastic disease, stroke can rarely be the first manifestation of an occult malignancy. We report a 46-year-old woman who presented with multiple cerebral infarctions in numerous vascular distributions, refractory to anticoagulation, and associated with systemic thromboses. These atypical features prompted a malignancy evaluation which revealed an occult lung adenocarcinoma. Our patient had a rapidly deteriorating course with recurrent strokes despite numerous anti-platelet and anti-coagulant agents, and was only responsive to chemotherapy aimed at the underlying cancer.
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Kwon HM, Kang BS, Yoon BW. Stroke as the first manifestation of concealed cancer. J Neurol Sci 2007; 258:80-3. [PMID: 17408695 DOI: 10.1016/j.jns.2007.02.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 02/27/2007] [Accepted: 02/28/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Trousseau's syndrome (TS) is defined as a malignancy-related thromboembolism occurring in patients with an underlying or undiagnosed malignancy. Stroke seldom occurs as the first manifestation of a cancer. We investigated the clinical and radiological features of patients with TS. METHODS We reviewed the clinical, pathologic, and radiological records of consecutive stroke patients, whose cancers were diagnosed at stroke presentation. Cancer-related stroke was defined if no definite cause was confirmed and malignancy was detected within 6 months of first stroke onset without cancer-related treatment. All patients underwent brain diffusion-weighted MRI (DWI), MR angiography, and echocardiography. The sizes, numbers, and locations of all hyperintense lesions in the DWI were noted. RESULTS Ten patients were finally analyzed. Histologically, cancers were often proven to adenocarcinomas (50%, 5/10) of advanced stage. Six of 10 patients tested (60%) had elevated D-dimer. Seven of the 10 patients (70%) showed bihemispheric anterior and posterior involvement. DWI features showed numerous small and medium or large lesions in multiple territories in 9 patients (90%). CONCLUSIONS The authors emphasize that when presented with multiple bihemispheric infarctions on DWI and an unknown etiology, the neurologist must consider the existence of a concealed cancer.
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Affiliation(s)
- Hyung-Min Kwon
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, Republic of Korea
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