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Zong X, Wang X, Liu S, Tang X, Zheng D. Isolated distal deep vein thrombosis associated with adenomyosis: Case report and literature review. Clin Case Rep 2024; 12:e8859. [PMID: 38725929 PMCID: PMC11079546 DOI: 10.1002/ccr3.8859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
While adenomyosis is commonly associated with a mild risk of thrombotic complications, the presence of additional thrombophilia factors can increase this risk, particularly in individuals with severe symptoms and elevated CA125 levels.
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Affiliation(s)
- Xiaolong Zong
- Department of Clinical LaboratoryThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Xuechao Wang
- Department of Clinical Laboratory, Tianjin Baodi HospitalBaodi Clinical College of Tianjin Medical UniversityTianjinChina
| | - Shenjia Liu
- Department of UltrasoundThe Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Xuemei Tang
- Department of Clinical LaboratoryZhouqu People's Hospital, Gannan Tibetan Autonomous PrefectureGansu ProvinceChina
| | - Dayong Zheng
- Department of Clinical Laboratory, Tianjin Baodi HospitalBaodi Clinical College of Tianjin Medical UniversityTianjinChina
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2
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Wang P, Tang J, Li T, Shang L, Zhang Q, Hu M. Trousseau's syndrome caused by hepatocellular carcinoma: a case description and literature analysis. Quant Imaging Med Surg 2024; 14:3762-3767. [PMID: 38720870 PMCID: PMC11074743 DOI: 10.21037/qims-23-1746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/18/2024] [Indexed: 05/12/2024]
Affiliation(s)
| | | | - Tianran Li
- Department of Radiology, Fourth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Liutong Shang
- Department of Radiology, Fourth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qun Zhang
- Department of Radiology, Fourth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Mingyan Hu
- Department of Radiology, Fourth Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
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Seki Y. Clinical guidelines for prevention and treatment of CAT in Japan and other countries. Int J Hematol 2024; 119:505-515. [PMID: 38558108 DOI: 10.1007/s12185-024-03736-w] [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: 11/01/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Cancer-associated thrombosis (CAT) is an important prognostic factor for an increasing number of cancer patients. Understanding of CAT among cancer care providers has grown in recent years, and guidelines for the prevention and treatment of CAT have been published in Japan and around the world. In this article, we introduce these major guidelines and discuss differences we identified between the Japanese guidelines and those of other countries, with a focus on problems and issues. Insurance coverage of low-molecular-weight heparin and indications for primary prevention with direct oral anticoagulants in particular require urgent consideration.
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Affiliation(s)
- Yoshinobu Seki
- Department of Hematology, Niigata University Medical and Dental Hospital, Chuoku Asahimachi-Dori 1, Niigata, 951-8520, Japan.
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Feldman S, Gupta D, Navi BB, Grace Ho KW, Willeit P, Devlin S, Bolton KL, Arcila ME, Mantha S. Tumor Genomic Profile Is Associated With Arterial Thromboembolism Risk in Patients With Solid Cancer. JACC CardioOncol 2023; 5:246-255. [PMID: 37144118 PMCID: PMC10152200 DOI: 10.1016/j.jaccao.2023.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 05/06/2023] Open
Abstract
Background Patients with cancer have an increased risk for arterial thromboembolism (ATE). Scant data exist about the impact of cancer-specific genomic alterations on the risk for ATE. Objectives The aim of this study was to determine whether individual solid tumor somatic genomic alterations influence the incidence of ATE. Methods A retrospective cohort study was conducted using tumor genetic alteration data from adults with solid cancers who underwent Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets testing between 2014 and 2016. The primary outcome, ATE, was defined as myocardial infarction, coronary revascularization, ischemic stroke, peripheral arterial occlusion, or limb revascularization and identified through systematic electronic medical record assessments. Patients were followed from date of tissue-matched blood control accession to first ATE event or death, for up to 1 year. Cause-specific Cox proportional hazards regression was used to determine HRs of ATE for individual genes adjusted for pertinent clinical covariates. Results Among 11,871 eligible patients, 74% had metastatic disease, and there were 160 ATE events. A significantly increased risk for ATE independent of tumor type was noted for the KRAS oncogene (HR: 1.98; 95% CI: 1.34-2.94; multiplicity-adjusted P = 0.015) and the STK11 tumor suppressor gene (HR: 2.51; 95% CI: 1.44-4.38; multiplicity-adjusted P = 0.015). Conclusions In a large genomic tumor-profiling registry of patients with solid cancers, alterations in KRAS and STK11 were associated with an increased risk for ATE independent of cancer type. Further investigation is needed to elucidate the mechanism by which these mutations contribute to ATE in this high-risk population.
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Affiliation(s)
- Stephanie Feldman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Babak B. Navi
- Department of Neurology and the Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ka-Wai Grace Ho
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Peter Willeit
- Clinical Epidemiology Team, Medical University of Innsbruck, Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Sean Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kelly L. Bolton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maria E. Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Simon Mantha
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Address for correspondence: Dr Simon Mantha, Memorial Sloan Kettering Cancer Center, Koch Center, 530 East 74th Street, New York, New York 10021, USA.
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Chen YJ, Dong RG, Zhang MM, Sheng C, Guo PF, Sun J. Cancer-related stroke: Exploring personalized therapy strategies. Brain Behav 2022; 12:e2738. [PMID: 35938982 PMCID: PMC9480895 DOI: 10.1002/brb3.2738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cancer and ischemic stroke are two common diseases that threaten human health and have become the main causes of death in the world. It is estimated that one-in-ten patients with ischemic stroke have concomitant cancer, and this incidence is expected to increase as improvements in medical technology extends the life expectancy of cancer patients. DISCUSSION Cancer-related stroke (CRS) refers to unexplained ischemic stroke in patients with active cancer that cannot be explained by current stroke mechanisms. Available evidence suggests that CRS accounts for 5-10% of embolic stroke of undetermined source (ESUS). Although the incidence of CRS is gradually increasing, its underlying pathogenesis remains unclear. Also, there is no consensus on acute treatment and secondary prevention of stroke. CONCLUSION In this review, we retrospectively analyzed the incidence, mechanisms of CRS, its potential as a new stroke subtype, options for acute treatment, secondary prevention strategies, and disease progression, with the aim of attempting to explore personalized therapy strategies.
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Affiliation(s)
- Yu-Jie Chen
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Rui-Guo Dong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou city, P.R. China
| | - Meng-Meng Zhang
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Chao Sheng
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Peng-Fei Guo
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
| | - Jie Sun
- Department of Neurological Rehabilitation, Xuzhou Central Hospital, Xuzhou city, P.R. China
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A Clot Waveform Analysis Showing a Hypercoagulable State in Patients with Malignant Neoplasms. J Clin Med 2021; 10:jcm10225352. [PMID: 34830633 PMCID: PMC8618625 DOI: 10.3390/jcm10225352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Objective: hypercoagulability in patients with malignant neoplasm were evaluated to examine the relationship with thrombosis. (2) Methods: clot waveform analysis (CWA)—activated partial thromboplastin time (APTT) and CWA—small amount of tissue factor induced FIX activation (sTF/FIXa) assays were performed in 92 patients with malignant neoplasm and the relationship between hypercoagulability and thrombosis was retrospectively examined. (3) Results: The study population included 92 patients with malignant neoplasms. Twenty-six (28.3%) had thrombotic diseases and 9 (9.8%) patients died within 28 days after the CWA. The peak time of the CWA-APTT could not show hypercoagulability in patients with malignant neoplasms. There were almost no significant differences in the peak times of the sTF/FIXa among patients with malignant neoplasms and healthy volunteers. In contrast, the peak heights of the CWA-sTF/FIXa in patients with various malignant neoplasms were significantly higher than those in healthy volunteers. Furthermore, among patients with malignant neoplasms, the peak heights of the sTF/FIXa in patients with thrombosis were significantly higher than those in patients without thrombosis. (4) Conclusions: although the routine APTT cannot evaluate the hypercoagulability, the peak heights of CWA-sTF/FIXa were significantly high in patients with malignant neoplasms, especially in those with thrombosis, suggesting that an elevated peak height of the CWA-sTF/FIXa may be a risk factor for thrombosis.
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Pfrepper C, Knödler M, Schorling RM, Seehofer D, Petros S, Lordick F. Predictors for thromboembolism in patients with cholangiocarcinoma. J Cancer Res Clin Oncol 2021; 148:2415-2426. [PMID: 34499224 PMCID: PMC9349130 DOI: 10.1007/s00432-021-03794-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with cancer are at increased risk of thromboembolic events contributing significantly to cancer-related morbidity and mortality. Because cholangiocarcinoma is a rare type of cancer, the incidence of thromboembolism in this patient population is not well defined. METHODS Patients with cholangiocarcinoma treated at the University Cancer Center Leipzig between January 2014 and December 2018 were analyzed retrospectively regarding the incidence of arterial and venous thromboembolism. RESULTS A total of 133 newly and consecutively diagnosed patients were included, of whom 22% had stage IV disease. Thromboembolism was diagnosed in 39 (29.3%), with 48% of the events occurring between 60 days prior and 30 days after the initial diagnosis. Arterial thrombosis accounted for 19% and portal venous thrombosis for 33% of the events, while the rest of events occurred in the non-portal venous system. In multivariable analysis, an ONKOTEV score ≥ 2 was the only independent predictor for thromboembolism. Serum CA 19-9 was available in 87 patients (65.4%). In this subgroup, CA 19-9 above the median of 97.7 U/ml and vascular or lymphatic compression were independent predictors for thromboembolism in the first year and CA 19-9 alone remained a significant predictor over the whole observation period. An ONKOTEV score ≥ 2 and increasing age were predictors of survival. CONCLUSIONS A very high thromboembolic risk was observed in cholangiocarcinoma, comparable to the risk situation in pancreatic and gastric cancer. The ONKOTEV score and serum CA 19-9 are independent predictors of thromboembolic events. Prospective validation of our observations in this patient population is warranted.
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Affiliation(s)
- Christian Pfrepper
- Department of Hematology, Cellular Therapy and Hemostaseology, Division of Hemostaseology, University of Leipzig Medical Center, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Maren Knödler
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Ruth Maria Schorling
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Vascular, Thoracic and Transplant Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Sirak Petros
- Department of Hematology, Cellular Therapy and Hemostaseology, Division of Hemostaseology, University of Leipzig Medical Center, Liebigstr. 20, 04103, Leipzig, Germany.,Medical ICU, University of Leipzig Medical Center, Leipzig, Germany
| | - Florian Lordick
- Department of Medicine (Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases), University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany
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Chong SL, Ahmad Asnawi AW, Hamzah R, Liew PK, Ong TC, Tan SM, Chang KM. Occult Disseminated Metastatic Breast Carcinoma Presenting as Acquired Thrombotic Thrombocytopenic Purpura. Case Rep Oncol 2021; 14:1814-1820. [PMID: 35111014 PMCID: PMC8787534 DOI: 10.1159/000521159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Cancer-related microangiopathic hemolytic anemia (MAHA) is a rare and life-threatening condition. We present a patient who had been treated for invasive lobular breast carcinoma in clinical remission with fever and hemolytic anemia. The peripheral blood film showed MAHA and thrombocytopenia, and a functional deficiency of ADAMTS13 activity of 23% consistent with acquired thrombotic thrombocytopenic purpura. Bone marrow aspirate and trephine biopsy confirmed metastatic carcinoma. Further evaluation revealed the involvement of multiple bone sites without recurrence of the primary tumor. The patient received a daily plasma exchange with cryosupernatant and was pulsed with corticosteroids. MAHA related to breast cancer appears to be a rare occurrence.
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Affiliation(s)
- Siew Lian Chong
- Department of Hematology, Hospital Ampang, Ampang, Malaysia
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Asral Wirda Ahmad Asnawi
- Department of Hematology, Hospital Ampang, Ampang, Malaysia
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | | | - Pek Kuen Liew
- Department of Hematology, Hospital Ampang, Ampang, Malaysia
| | - Tee Chuan Ong
- Department of Hematology, Hospital Ampang, Ampang, Malaysia
| | - Sen Mui Tan
- Department of Hematology, Hospital Ampang, Ampang, Malaysia
| | - Kian Meng Chang
- Department of Medicine, Sunway Medical Centre, Petaling Jaya, Malaysia
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9
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Wang Z, Miao J, Wang L, Liu Y, Ji H, Zhang X, Cui L. EGFR-mutant NSCLC presenting with stroke and massive systemic embolization as the first manifestation: case report. BMC Neurol 2021; 21:221. [PMID: 34107910 PMCID: PMC8188717 DOI: 10.1186/s12883-021-02236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022] Open
Abstract
Background Presentation with massive systemic embolization as the initial manifestation of occult malignancy is infrequent. The standard management of cancer-related arterial thromboembolism has not yet been established. Case presentation We described a case of Trousseau’s syndrome resulting in acute ischemic stroke concomitant with multiple embolizations in the spleen and kidney during oral administration of dabigatran for pulmonary embolism preceding the diagnosis of a malignant tumor. A cancer-related hypercoagulable state was suspected because the patient was admitted to the neurology department due to acute ischemic stroke with three territory infarcts on diffusion-weighted imaging (DWI) in the absence of identifiable conventional risk factors and brain vessel narrowing. The patient was subsequently diagnosed with epidermal growth factor receptor (EGFR) mutation–positive non-small-cell lung cancer (NSCLC) (stage IV) with pleural metastasis. Administration of low-molecular-weight heparin followed by long-term dabigatran under effective cancer therapy comprising gefitinib and subsequent chemotherapy did not cause stroke relapse during the 1-year follow-up. Conclusions This case suggests that cancer-related hypercoagulability should be considered an important etiology for stroke patients who develop unexplained disseminated acute cerebral infarction without conventional stroke risk factors, especially concomitant with multiple organ embolization. Novel oral anticoagulants may be an alternative therapy for the long-term management of cancer-related arterial thromboembolism under effective cancer therapy.
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Affiliation(s)
- Zheng Wang
- Department of Respiratory Medicine III, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiangyong Miao
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China.,Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Shijiazhuang, Hebei, China
| | - Lina Wang
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China
| | - Ying Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China
| | - Hui Ji
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China
| | - Xiangjian Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China.,Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Shijiazhuang, Hebei, China
| | - Lili Cui
- Department of Neurology, The Second Hospital of Hebei Medical University, 309 Zhonghuabei Street, Hebei, 050000, Shijiazhuang, People's Republic of China. .,Hebei Key Laboratory of Vascular Homeostasis and Hebei Collaborative Innovation Center for Cardio-cerebrovascular Disease, Shijiazhuang, Hebei, China.
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Ma SN, Mao ZX, Wu Y, Liang MX, Wang DD, Chen X, Chang PA, Zhang W, Tang JH. The anti-cancer properties of heparin and its derivatives: a review and prospect. Cell Adh Migr 2021; 14:118-128. [PMID: 32538273 PMCID: PMC7513850 DOI: 10.1080/19336918.2020.1767489] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Heparin, including unfractionated heparin (UFH), low-molecular-weight heparin (LMWH) and heparin derivatives, are commonly used in venous thromboembolism treatment and reportedly have beneficial effects on cancer survival. Heparin can affect the proliferation, adhesion, angiogenesis, migration and invasion of cancer cells via multiple mechanisms. The main mechanisms involve inhibition of heparanase, P-/L-selectin, angiogenesis, and interference with the CXCL12-CXCR4 axis. Here we summarize the current experimental evidence regarding the anti-cancer role of heparin and its derivatives, and conclude that there is evidence to support heparin’s role in inhibiting cancer progression, making it a promising anti-cancer agent.
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Affiliation(s)
- Sai-Nan Ma
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China.,Department of Oncology, The Affiliated Suqian Hospital of Xuzhou Medical University , Suqian, P.R.China
| | - Zhi-Xiang Mao
- Department of Oncology, Affiliated Hospital of Xuzhou Medical University , Xuzhou, P.R. China
| | - Yang Wu
- Core Facility, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China
| | - Ming-Xing Liang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China
| | - Dan-Dan Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China
| | - Xiu Chen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China
| | - Ping-An Chang
- Urinary Surgery, Dongtai People's Hospital , Dongtai, P.R. China
| | - Wei Zhang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China
| | - Jin-Hai Tang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University , Nanjing, P.R. China
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Desikan SP, Mclaughlin N, McClain C, Desikan R. Recurrent Colon Cancer: Presentation With Disseminated Intravascular Coagulation From Disseminated Carcinomatosis of the Bone Marrow. J Investig Med High Impact Case Rep 2021; 9:23247096211012224. [PMID: 33966469 PMCID: PMC8114248 DOI: 10.1177/23247096211012224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Diffuse carcinomatosis of the bone marrow (DCBM) is a rare clinical condition characterized by diffuse bone marrow involvement with hematological changes. This case study concerns a patient who presented with DCBM secondary to colon cancer with diffuse intravascular coagulation. This is a rare presentation of DCBM in colon cancer. The case study also elaborates on clinical features, pathogenesis, and therapy of this unique presentation.
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Shah S, Karathanasi A, Revythis A, Ioannidou E, Boussios S. Cancer-Associated Thrombosis: A New Light on an Old Story. Diseases 2021; 9:34. [PMID: 34064390 PMCID: PMC8161803 DOI: 10.3390/diseases9020034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/08/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer-associated thrombosis (CAT) is a rising and significant phenomenon, becoming the second leading cause of death in cancer patients. Pathophysiology of CAT differs from thrombosis in the non-cancer population. There are additional risk factors for thrombosis specific to cancer including cancer type, histology, and treatment, such as chemotherapy. Recently developed scoring systems use these risk factors to stratify the degree of risk and encourage thromboprophylaxis in intermediate- to high-risk patients. Anticoagulation is safely used for prophylaxis and treatment of CAT. Both of these have largely been with low-molecular-weight heparin (LMWH), rather than the vitamin K antagonist (VKA); however, there has been increasing evidence for direct oral anticoagulant (DOAC) use. Consequently, international guidelines have also adapted to recommend the role of DOACs in CAT. Using DOACs is a turning point for CAT, but further research is warranted for their long-term risk profile. This review will discuss mechanisms, risk factors, prophylaxis and management of CAT, including both LMWH and DOACs. There will also be a comparison of current international guidelines and how they reflect the growing evidence base.
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Affiliation(s)
- Sidrah Shah
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK; (S.S.); (A.K.); (A.R.)
| | - Afroditi Karathanasi
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK; (S.S.); (A.K.); (A.R.)
| | - Antonios Revythis
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK; (S.S.); (A.K.); (A.R.)
| | - Evangelia Ioannidou
- Department of Paediatrics and Child Health, West Suffolk Hospital NHS Foundation Trust, Hardwick Lane, Bury St Edmunds IP33 2QZ, UK;
| | - Stergios Boussios
- Department of Hematology/Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, UK; (S.S.); (A.K.); (A.R.)
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- AELIA Organization, 9th Km Thessaloniki-Thermi, 57001 Thessaloniki, Greece
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Sialoglycan recognition is a common connection linking acidosis, zinc, and HMGB1 in sepsis. Proc Natl Acad Sci U S A 2021; 118:2018090118. [PMID: 33658363 PMCID: PMC7958265 DOI: 10.1073/pnas.2018090118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sepsis is a condition wherein a microbial infection leads to life-threatening systemic hyperactivation of innate immunity. Blood pH is normally maintained tightly between 7.35 and 7.45, and lactic acidosis with a pH <7.3 indicates a poor prognosis in sepsis, also associated with low zinc levels. Release of HMGB1 from activated and/or necrotic tissues plays a pivotal role in triggering the proinflammatory cascade of late sepsis. Using an in vitro whole-blood assay, we observed that HMGB1 cannot mediate proinflammatory activity at physiological pH and zinc concentrations. This is due to zinc-dependent association of HMGB1 with sialoglycoproteins, thereby preventing its binding with proinflammatory receptors. Thus, a drop in pH and zinc concentration in sepsis can release sequestered HMGB1 and trigger the inflammatory cascade. Blood pH is tightly maintained between 7.35 and 7.45, and acidosis (pH <7.3) indicates poor prognosis in sepsis, wherein lactic acid from anoxic tissues overwhelms the buffering capacity of blood. Poor sepsis prognosis is also associated with low zinc levels and the release of High mobility group box 1 (HMGB1) from activated and/or necrotic cells. HMGB1 added to whole blood at physiological pH did not bind leukocyte receptors, but lowering pH with lactic acid to mimic sepsis conditions allowed binding, implying the presence of natural inhibitor(s) preventing binding at normal pH. Testing micromolar concentrations of divalent cations showed that zinc supported the robust binding of sialylated glycoproteins with HMGB1. Further characterizing HMGB1 as a sialic acid-binding lectin, we found that optimal binding takes place at normal blood pH and is markedly reduced when pH is adjusted with lactic acid to levels found in sepsis. Glycan array studies confirmed the binding of HMGB1 to sialylated glycan sequences typically found on plasma glycoproteins, with binding again being dependent on zinc and normal blood pH. Thus, HMGB1-mediated hyperactivation of innate immunity in sepsis requires acidosis, and micromolar zinc concentrations are protective. We suggest that the potent inflammatory effects of HMGB1 are kept in check via sequestration by plasma sialoglycoproteins at physiological pH and triggered when pH and zinc levels fall in late stages of sepsis. Current clinical trials independently studying zinc supplementation, HMGB1 inhibition, or pH normalization may be more successful if these approaches are combined and perhaps supplemented by infusions of heavily sialylated molecules.
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Alhenc-Gelas M, Cabel L, Berger F, Delaloge S, Frenel JS, Levy C, Firmin N, Ladoire S, Desmoulins I, Heudel PE, Dalenc F, Loirat D, Dubot C, Vuagnat P, Deluche E, Mokdad-Adi M, Patsouris A, Annic J, Djerroudi L, Lavigne M, Pierga JY, Coppo P, Bidard FC. Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study. Breast Cancer Res 2021; 23:9. [PMID: 33468209 PMCID: PMC7814553 DOI: 10.1186/s13058-021-01386-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA. METHODS Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitabine- or bevacizumab-based treatment. Patient characteristics, treatments and outcome were retrieved from digital medical records. RESULTS Individual data from 54 patients with breast cancer-related MAHA were obtained from 7 centres. Twenty-three (44%) patients had a breast tumour with lobular features, and most primary tumours were low grade (grade I/II, N = 39, 75%). ER+/HER2-, HER2+ and triple-negative phenotypes accounted for N = 33 (69%), N = 7 (15%) and N = 8 (17%) cases, respectively. All patients had stage IV cancer at the time of MAHA diagnosis. Median overall survival (OS) was 28 days (range 0-1035; Q1:10, Q3:186). Independent prognostic factors for early death (≤ 28 days) were PS > 2 (OR = 7.0 [1.6; 31.8]), elevated bilirubin (OR = 6.9 [1.1; 42.6]), haemoglobin < 8.0 g/dL (OR = 3.7 [0.9; 16.7]) and prothrombin time < 50% (OR = 9.1 [1.2; 50.0]). A score to predict early death displayed a sensitivity of 86% (95% CI [0.67; 0.96]), a specificity of 73% (95% CI [0.52; 0.88]) and an area under the curve of 0.90 (95% CI [0.83; 0.97]). CONCLUSIONS Breast cancer-related MAHA appears to be a new feature of invasive lobular breast carcinoma. Prognostic factors and scores may guide clinical decision-making in this serious but not always fatal condition.
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Affiliation(s)
- Marion Alhenc-Gelas
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Institut de cancérologie de Montpellier INSERM U1194, Montpellier, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | | | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-Oncopole), Toulouse, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Elise Deluche
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Meriem Mokdad-Adi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Josselin Annic
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Université de Paris, Paris, France
| | - Paul Coppo
- Reference Center for Thrombotic Microangiopathies (CNR-MAT), AP-HP.SU, INSERM UMRS, 1138, Paris, France.,Sorbonne University, Paris, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France. .,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France.
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15
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Fang L, Xu Q, Qian J, Zhou JY. Aberrant Factors of Fibrinolysis and Coagulation in Pancreatic Cancer. Onco Targets Ther 2021; 14:53-65. [PMID: 33442266 PMCID: PMC7797325 DOI: 10.2147/ott.s281251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
Aberrant factors associated with fibrinolysis and thrombosis are found in many cancer patients, which can promote metastasis and are associated with poor prognosis. The relationship between tumor-associated fibrinolysis and thrombosis is poorly understood in pancreatic cancer. This review provides a brief highlight of existing studies that the fibrinolysis and coagulation systems were activated in pancreatic cancer patients, along with aberrant high concentrations of tissue plasminogen activator (t-PA), urine plasminogen activator (u-PA), D-dimer, fibrinogen, or platelets. These factors cooperate with each other, propelling tumor cell shedding, localization, adhesion to distant metastasis. The relationship between thrombosis or fibrinolysis and cancer immune escape is also investigated. In addition, the potential prevention and therapy strategies of pancreatic cancer targeting factors in fibrinolysis and coagulation systems are also been discussed, in which we highlight two effective agents aspirin and low-molecular weight heparin (LMWH). Summarily, this review provides new directions for the research and treatment of pancreatic cancer.
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Affiliation(s)
- Lianghua Fang
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, People's Republic of China
| | - Qing Xu
- Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210029, People's Republic of China
| | - Jun Qian
- Department of Oncology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, People's Republic of China
| | - Jin-Yong Zhou
- Central Laboratory, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, People's Republic of China
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16
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Boey T, Sule AA, Sule AA. Successful Treatment of Recurrent Thrombosis Associated with Malignancy with Apixaban and Follow-up for 1 Year. Int J Angiol 2020; 29:256-259. [PMID: 33268977 DOI: 10.1055/s-0039-1694780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
This case report aims to highlight a successful example of using novel oral anticoagulants (NOACs), such as apixaban, to prevent recurrent venous thromboembolism (VTE) in patients with solid-organ malignancy, as an alternative to low-molecular weight heparin (LMWH). Discussed is the case of a 67-year-old woman diagnosed with recurrent thrombosis in the upper-right limb and malignancy of right breast with metastasis to the axillary lymph nodes. Over a follow-up period of more than 1 year, there was no recurrence of VTE and D-dimer decreased, illuminating the possibility of apixaban as an alternative form of treatment for recurrent VTE in patients with malignancy. This appears to be one of the first case reports in Singapore.
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Affiliation(s)
| | | | - Ashish Anil Sule
- Department of General Medicine, Vascular Medicine and Hypertension, Tan Tock Seng Hospital, Singapore
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17
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Trousseau's syndrome associated with rapidly emerging pancreatic adenocarcinoma soon after esophagectomy: A case report. Int J Surg Case Rep 2020; 77:605-609. [PMID: 33395856 PMCID: PMC7708758 DOI: 10.1016/j.ijscr.2020.11.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/20/2022] Open
Abstract
The first reported case of Trousseau’s syndrome associated with rapidly emerging pancreatic cancer potentially triggered esophagectomy. The aggressively emerging pancreatic cancer with mucin production may be a potential mechanism for cancer-related thrombosis. When a patient with cancer encountered small, multiple cerebral infarctions postoperatively, the body should be checked for occult malignancy.
Introduction Trousseau’s syndrome is characterized as an unexpected, cancer-associated thrombotic event. We describe the first reported case of Trousseau’s syndrome associated with rapidly emerging pancreatic cancer potentially triggered by esophagectomy. Presentation of case A 79-year-old asymptomatic male with clinical stage I esophageal squamous cell carcinoma underwent thoracoscopic subtotal esophagectomy. On postoperative day 46, the patient presented with weakness of his left upper extremity due to multiple cerebral and cerebellar infarctions, with no evidence of atherosclerotic or cardiogenic thrombi. An abdominal computed tomography (CT) showed a pancreatic tumor with multiple liver metastases. Extremely high D-dimer and the CT findings suggested Trousseau’s syndrome associated with a rapidly emerging neoplasm as the etiology of the brain infarction. Although further thrombotic events did not occur, his condition deteriorated rapidly and died on the 31st days of onset. The autopsy revealed multiple small infarctions, with multiple thrombi in the cerebral hemispheres, brain stem, and cerebellum. Histological evaluation revealed pancreatic adenocarcinoma with nodal and liver metastases. Discussion A hypercoagulable state associated with the aggressively emerging pancreatic adenocarcinoma, accompanied by cancer cell production of mucin, may be a potential mechanism for cancer-related thrombosis. Conclusion In patients who received intensive surgical treatment and encountered unexplained brain infarctions in the multi-arterial territory, Trousseau’s syndrome should be considered, and investigation for occult malignancy is required.
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18
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Beatson R, Graham R, Grundland Freile F, Cozzetto D, Kannambath S, Pfeifer E, Woodman N, Owen J, Nuamah R, Mandel U, Pinder S, Gillett C, Noll T, Bouybayoune I, Taylor-Papadimitriou J, Burchell JM. Cancer-associated hypersialylated MUC1 drives the differentiation of human monocytes into macrophages with a pathogenic phenotype. Commun Biol 2020; 3:644. [PMID: 33149188 PMCID: PMC7642421 DOI: 10.1038/s42003-020-01359-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
The tumour microenvironment plays a crucial role in the growth and progression of cancer, and the presence of tumour-associated macrophages (TAMs) is associated with poor prognosis. Recent studies have demonstrated that TAMs display transcriptomic, phenotypic, functional and geographical diversity. Here we show that a sialylated tumour-associated glycoform of the mucin MUC1, MUC1-ST, through the engagement of Siglec-9 can specifically and independently induce the differentiation of monocytes into TAMs with a unique phenotype that to the best of our knowledge has not previously been described. These TAMs can recruit and prolong the lifespan of neutrophils, inhibit the function of T cells, degrade basement membrane allowing for invasion, are inefficient at phagocytosis, and can induce plasma clotting. This macrophage phenotype is enriched in the stroma at the edge of breast cancer nests and their presence is associated with poor prognosis in breast cancer patients. Beatson et al. show that a sialylated tumour-associated glycoform of the mucin MUC1 induces the differentiation of monocytes into tumour-associated macrophages. These macrophages are found in breast cancer stroma and their presence is associated with poor prognosis.
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Affiliation(s)
- Richard Beatson
- Breast Cancer Biology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK.
| | - Rosalind Graham
- Breast Cancer Biology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Fabio Grundland Freile
- Breast Cancer Biology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Domenico Cozzetto
- Translational Bioinformatics, Genomics Facility, National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 9RT, UK
| | - Shichina Kannambath
- Genomics Facility, National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 9RT, UK
| | - Ester Pfeifer
- Breast Cancer Biology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Natalie Woodman
- KHP Tissue Bank, Breast Pathology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Julie Owen
- KHP Tissue Bank, Breast Pathology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Rosamond Nuamah
- Genomics Facility, National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, SE1 9RT, UK
| | - Ulla Mandel
- Copenhagen Centre for Glycomics, Departments of Cellular and Molecular Medicine and Odontology, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3, 2200N, Copenhagen, Denmark
| | - Sarah Pinder
- Breast Pathology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Cheryl Gillett
- KHP Tissue Bank, Breast Pathology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Thomas Noll
- Cell Culture Technology, Faculty of Technology & CeBiTec, Bielefeld University, P.O. Box 10 01 31, 33501, Bielefeld, Germany
| | - Ihssane Bouybayoune
- Breast Pathology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Joyce Taylor-Papadimitriou
- Breast Cancer Biology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK
| | - Joy M Burchell
- Breast Cancer Biology, Comprehensive Cancer Centre, King's College London, Guy's Cancer Centre, Guy's Hospital, London, SE1 9RT, UK.
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19
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Popper H. Primary tumor and metastasis-sectioning the different steps of the metastatic cascade. Transl Lung Cancer Res 2020; 9:2277-2300. [PMID: 33209649 PMCID: PMC7653118 DOI: 10.21037/tlcr-20-175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patients with lung cancer in the majority die of metastases. Treatment options include surgery, chemo- and radiotherapy, targeted therapy by tyrosine kinase inhibitors (TKIs), and immuno-oncologic treatment. Despite the success with these treatment options, cure of lung cancer is achieved in only a very small proportion of patients. In most patients’ recurrence and metastasis will occur, and finally kill the patient. Metastasis is a multistep procedure. It requires a change in adhesion of tumor cells for detachment from their neighboring cells. The next step is migration either as single cells [epithelial-mesenchymal transition (EMT)], or as cell clusters (hybrid-EMT or bulk migration). A combination of genetic changes is required to facilitate migration. Then tumor cells have to orient themselves along matrix proteins, detect oxygen concentrations, prevent attacks by immune cells, and induce a tumor-friendly switch of stroma cells (macrophages, myofibroblasts, etc.). Having entered the blood stream tumor cells need to adapt to shear stress, avoid being trapped by coagulation, but also use coagulation in small veins for adherence to endothelia, and express homing molecules for extravasation. Within a metastatic site, tumor cells need a well-prepared niche to establish a metastatic focus. Tumor cells again have to establish a vascular net for maintaining nutrition and oxygen supply, communicate with stroma cells, grow out and set further metastases. In this review the different steps will be discussed with a focus on pulmonary carcinomas. The vast amount of research manuscripts published so far are not easy to analyze: in most reports’ single steps of the metastatic cascade are interpreted as evidence for the whole process; for example, migration is interpreted as evidence for metastasis. In lung cancer most often latency periods are shorter, in between 1–5 years. In other cases, despite widespread migration occurs, tumor cells die within the circulation and do not reach a metastatic site. Therefore, migration is a requisite, but does not necessarily predict metastasis. The intention of this review is to point to these different aspects and hopefully provoke research directed into a more functional analysis of the metastatic process.
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Affiliation(s)
- Helmut Popper
- Institute of Pathology, Medical University of Graz, Graz, Austria
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20
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Drilon A, Jenkins C, Iyer S, Schoenfeld A, Keddy C, Davare MA. ROS1-dependent cancers - biology, diagnostics and therapeutics. Nat Rev Clin Oncol 2020; 18:35-55. [PMID: 32760015 DOI: 10.1038/s41571-020-0408-9] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
The proto-oncogene ROS1 encodes a receptor tyrosine kinase with an unknown physiological role in humans. Somatic chromosomal fusions involving ROS1 produce chimeric oncoproteins that drive a diverse range of cancers in adult and paediatric patients. ROS1-directed tyrosine kinase inhibitors (TKIs) are therapeutically active against these cancers, although only early-generation multikinase inhibitors have been granted regulatory approval, specifically for the treatment of ROS1 fusion-positive non-small-cell lung cancers; histology-agnostic approvals have yet to be granted. Intrinsic or extrinsic mechanisms of resistance to ROS1 TKIs can emerge in patients. Potential factors that influence resistance acquisition include the subcellular localization of the particular ROS1 oncoprotein and the TKI properties such as the preferential kinase conformation engaged and the spectrum of targets beyond ROS1. Importantly, the polyclonal nature of resistance remains underexplored. Higher-affinity next-generation ROS1 TKIs developed to have improved intracranial activity and to mitigate ROS1-intrinsic resistance mechanisms have demonstrated clinical efficacy in these regards, thus highlighting the utility of sequential ROS1 TKI therapy. Selective ROS1 inhibitors have yet to be developed, and thus the specific adverse effects of ROS1 inhibition cannot be deconvoluted from the toxicity profiles of the available multikinase inhibitors. Herein, we discuss the non-malignant and malignant biology of ROS1, the diagnostic challenges that ROS1 fusions present and the strategies to target ROS1 fusion proteins in both treatment-naive and acquired-resistance settings.
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Affiliation(s)
- Alexander Drilon
- Early Drug Development and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Chelsea Jenkins
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Sudarshan Iyer
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Adam Schoenfeld
- Early Drug Development and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Clare Keddy
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Monika A Davare
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
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21
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Chen Y, Zhang C, Wang X, Han L, Zhu S, Liu Y, Wang R, Geng Z, Ma C, Dong R. Suitability of Thrombolysis for Patients With Acute Ischemic Stroke Complicated With Trousseau Syndrome. Front Neurosci 2020; 14:481. [PMID: 32595439 PMCID: PMC7303462 DOI: 10.3389/fnins.2020.00481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
Intravenous thrombolysis (IVT) improves functional outcome after acute ischemic stroke (AIS) and is the standard first-line treatment; however, it is associated with many complications, including cerebral hemorrhage. Cancer patients are susceptible to thrombotic events – collectively referred to as Trousseau syndrome (TS) – owing to their hypercoagulable state. Here, we describe the case of a 55-year-old male with a history of hypertension for over 10 years who underwent surgery for removal of a cancer of lower esophagus, with no subsequent treatment. Three months later, he was admitted to the emergency department of our hospital with sudden dizziness and incoherent speech. Brain computed tomography revealed multiple cerebral infarctions. The patient was treated by IVT with tissue plasminogen activator (rtPA) after the onset of symptoms, which improved by the end of the treatment. However, a few months later, he experienced a recurrence of cerebral infarction and hemorrhage, which has rarely been reported. The clinical course of this case suggests that the suitability of thrombolysis with rtPA in the acute phase of cerebral infarction complicated with TS should be carefully considered.
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Affiliation(s)
- Yujie Chen
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chundi Zhang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xin Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Long Han
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Shiguang Zhu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yan Liu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rui Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ziyang Geng
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chenchen Ma
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ruiguo Dong
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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22
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Four cases of Trousseau syndrome associated with breast cancer that exhibited central nervous system manifestations. Int Cancer Conf J 2020; 9:146-150. [PMID: 32582520 DOI: 10.1007/s13691-020-00411-9] [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: 01/13/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
Cancer-associated thrombosis is known as Trousseau syndrome (TS). Here, we report 4 cases of TS associated with advanced breast cancer that caused central nervous system (CNS) vascular events. All 4 patients experienced sudden onset of CNS symptoms. Imaging revealed multiple brain infarctions or intracranial hemorrhage and all 4 patients had leptomeningeal or brain metastasis. Laboratory findings showed hypercoagulability at diagnosis of TS. Of the 4 patients, 2 patients were treated with unfractionated heparin, while 2 patients could not undergo anticoagulant therapy. In all patients, once the TS occurred, the CNS symptoms progressed rapidly and the prognosis was very poor, 3 patients dying within about a month of diagnosis of TS. Therefore, the predictive factors of TS are important and standards and guidelines for administration of anticoagulants are needed.
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23
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A Case of Trousseau's Syndrome Accompanying Ovarian Cancer with Widespread Thromboembolisms. Case Rep Obstet Gynecol 2020; 2020:3738618. [PMID: 32566336 PMCID: PMC7293738 DOI: 10.1155/2020/3738618] [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: 03/18/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/04/2022] Open
Abstract
The patient was a 41-year-old woman, gravida 0. She had no notable medical history. Laparoscopic right salpingo-oophorectomy and left cystectomy were performed for bilateral ovarian endometriomas, which were both pathologically diagnosed as benign. Six months later, she presented with left lower abdominal pain and expressive aphasia. Examination revealed multiple cerebral infarctions and pulmonary embolism. The patient was diagnosed with Trousseau's syndrome secondary to ovarian cancer, and anticoagulant therapy was initiated. Despite treatment, she developed visual field loss due to occlusion of the left retinal artery; dizziness due to cerebellar infarction and myocardial infarction; and right hemiplegia due to new cerebral infarction. She received chemotherapy (two courses of paclitaxel and carboplatin), which did not improve her condition, and died two months after onset. An autopsy revealed that her left ovary was enlarged to a size of 12 cm and an endometrioid carcinoma G2 was identified. Ovarian cancer had spread throughout the abdominal cavity, and a large amount of pleural and ascites fluid was present. Multiple thrombi were found in bilateral pulmonary arteries and bilateral common iliac veins. There was a 2.5 cm thrombus in the left ventricle apex, and the anterior descending branch was obstructed by thrombus with recanalization.
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24
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Sasaki R, Ohya Y, Hayashida S, Maeda Y, Murahashi S, Kumamoto S, Tsuji A, Shibata H, Kuramoto K, Hayashi H, Kuriwaki K, Iizaka M, Nakahara O, Inomata Y. A case of Trousseau's syndrome due to intrahepatic cholangiocarcinoma with an extremely high level of CA19-9. Surg Case Rep 2020; 6:75. [PMID: 32307602 PMCID: PMC7167392 DOI: 10.1186/s40792-020-00835-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Trousseau's syndrome is a cancer-associated thrombosis. Trousseau's syndrome with cholangiocarcinoma is a rare condition with poor prognosis. CASE PRESENTATION A 59-year-old female was admitted to our hospital with abdominal pain, headache, and nausea. Abdominal enhanced computed tomography revealed liver tumor, splenic infarction, and bilateral renal infarction. Multiple acute cerebral infarctions were also detected by magnetic resonance imaging. Her preoperative serum levels of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were > 120,000 U/mL and 589.6 ng/mL, respectively, which were extremely high. Histopathology after right hepatectomy revealed moderately differentiated adenocarcinoma consistent with intrahepatic cholangiocarcinoma. Her serum levels of CA19-9 were trending down to 9029.2 and 2659.8 U/mL at 1 and 3 weeks after surgery, respectively. However, at 7 weeks after surgery, her CA19-9 levels increased in the presence of positive imaging findings in the remnant liver, hilar lymph nodes, and peritoneal cavity. The initiation of combination chemotherapy including gemcitabine and cisplatin had a significant effect. The patient was doing well at 6 months after the surgery. CONCLUSION This rare case of Trousseau's syndrome due to cholangiocarcinoma suggests that extremely high CA19-9 levels might be a pathogenic factor of this syndrome.
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Affiliation(s)
- Ryosuke Sasaki
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yuki Ohya
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
| | - Shintaro Hayashida
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yuto Maeda
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Shuei Murahashi
- Department of Neurology, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Sayahito Kumamoto
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Akira Tsuji
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Hidekatsu Shibata
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Kunitaka Kuramoto
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Hironori Hayashi
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Kazumi Kuriwaki
- Department of Diagnostic Pathology, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Masayoshi Iizaka
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Osamu Nakahara
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
| | - Yukihiro Inomata
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan
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25
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Fehr M, Hawle H, Hayoz S, Thuss-Patience P, Schacher S, Riera Knorrenschild J, Dürr D, Knoefel WT, Rumpold H, Bitzer M, Zweifel M, Samaras P, Mey U, Küng M, Winterhalder R, Eisterer W, Hess V, Gérard MA, Templeton A, Stahl M, Ruhstaller T. High thromboembolic event rate in patients with locally advanced oesophageal cancer during neoadjuvant therapy. An exploratory analysis of the prospective, randomised intergroup phase III trial SAKK 75/08. BMC Cancer 2020; 20:166. [PMID: 32111181 PMCID: PMC7048062 DOI: 10.1186/s12885-020-6623-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background High rates of venous thromboembolic events (VTEs), mainly in advanced disease, are reported for patients with cancer of the upper gastrointestinal tract (stomach, pancreas) and for treatment with cisplatin. Methods Exploratory analysis of VTEs reported as adverse events and serious adverse events in a prospective, randomised, multicentre, multimodal phase III trial according to VTEs reported as adverse events and severe adverse events. Patients with resectable oesophageal cancer (T2N1–3, T3-4aNx) were randomized to 2 cycles of chemotherapy with docetaxel 75 mg/m2, cisplatin 75 mg/m2 followed by chemo-radiotherapy (CRT) and subsequent surgery (control arm) or the same treatment with addition of cetuximab (investigational arm). Results VTEs occurred in 26 of 300 patients included in the trial, resulting in an incidence rate (IR) of 8.7% [95% CI 5.7–12.4%]. A total of 29 VTEs were reported:13 (45%) VTEs were grade 2, 13 (45%) grade 3 and three (10%) fatal grade 5 events. 72% (21/29) of all VTEs occurred preoperatively (IR 6.7%): 14% (4/29) during chemotherapy and 59% (17/29) during CRT. In multivariable logistic regression only adenocarcinoma (IR 11.1%, 21/189 patients) compared to squamous cell cancer (IR 4.5%, 5/111 patients) was significantly associated with VTE-risk during treatment, OR 2.9 [95%CI 1.0–8.4], p = 0.046. Baseline Khorana risk score was 0 in 73% (19/26), 1–2 in 23% (6/26) and 3 in only 4% (1/26) of patients with VTEs. Conclusion A high incidence of VTEs during preoperative therapy of resectable oesophageal cancer is observed in this analysis, especially in patients with adenocarcinoma. The role of prophylactic anticoagulation during neoadjuvant therapy in resectable esophageal cancer should be further evaluated in prospective clinical trials. According to our data, which are in line with other analysis of VTE-risk in patients with oesophageal cancer patients treated with neoadjuvant cisplatin-based chemotherapy and CRT, prophylactic anticoagluation could be considered balanced against individual bleeding risks, especially in patients with adenocarcinoma. In addition to the established risk factors, oesophageal adenocarcinoma treated with neoadjuvant cisplatin-based therapy may be regarded as a high-risk situation for VTEs. Trial registration Registered at clinicaltrials.gov,NCT01107639, on 21 April 2010,
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Affiliation(s)
- Martin Fehr
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | | | | | | | | | | | - Donat Dürr
- Stadtspital Triemli, Zürich, Switzerland
| | | | - Holger Rumpold
- Krankenhaus der barmherzigen Schwestern, Linz, Austria.,Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | | | | | | | - Ulrich Mey
- Kantonsspital Graubünden, Chur, Switzerland
| | - Marc Küng
- Hôpital Fribourgeois, Villars-sur-Glâne, Switzerland
| | | | - Wolfgang Eisterer
- Medizinische Universität Innsbruck, Innsbruck, Austria.,Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | | | | | | | | | - Thomas Ruhstaller
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.,University of Basel, Basel, Switzerland
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26
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Okada S, Miyagawa-Hayashino A, Fujinami J, Nishimura T, Ishikawa N, Tsunezuka H, Shimomura M, Shimada J, Inoue M. Trousseau's syndrome associated with pulmonary pleomorphic carcinoma exhibiting aggressive features: A case report. Mol Clin Oncol 2019; 12:36-40. [PMID: 31814975 PMCID: PMC6888249 DOI: 10.3892/mco.2019.1947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/17/2019] [Indexed: 12/04/2022] Open
Abstract
Trousseau's syndrome is characterized as an unexpected, cancer-related thrombotic event, such as a cerebral infarction or a deep vein thrombosis/pulmonary embolism. We describe the first reported case of Trousseau's syndrome with pulmonary pleomorphic carcinoma and aggressive features. A 74 year-old man presenting with a pulmonary mass, which was identified as pleomorphic carcinoma with extensive lymph node involvement, in the left lower lobe, underwent a left lower lobectomy. Immunohistochemical analysis revealed that neoplastic cells exhibited an extensive expression of tissue factors with a mucin-producing adenocarcinoma component. Three months postoperatively, diffuse infiltration rapidly appeared in the left lung, which was identified as lymphangitic carcinomatosis via bronchoscopy. Prior to treatment for cancer recurrence, the patient presented with a left hemiplegia due to a cerebral infarction via multiple thromboses, with no evidence of atherosclerotic or cardiogenic thrombi. Elevated D-dimer and carbohydrate antigen 125 levels and the presence of a fibrin thrombus retrieved from the occluded vessel suggested Trousseau's syndrome as the etiology of the brain infarction. A hypercoagulable state associated with the aggressive recurrence of pulmonary pleomorphic carcinoma, accompanied by cancer cell production of mucin and tissue factors may be a potential mechanism for cancer-related thrombosis.
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Affiliation(s)
- Satoru Okada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Aya Miyagawa-Hayashino
- Division of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Jun Fujinami
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Tomoki Nishimura
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Narumi Ishikawa
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Hiroaki Tsunezuka
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masanori Shimomura
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Junichi Shimada
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Masayoshi Inoue
- Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
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27
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Suzuki-Inoue K. Platelets and cancer-associated thrombosis: focusing on the platelet activation receptor CLEC-2 and podoplanin. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:175-181. [PMID: 31808911 PMCID: PMC6913448 DOI: 10.1182/hematology.2019001388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients with cancer have an increased risk of thromboembolism, which is the second leading cause of death in these patients. Several mechanisms of the prothrombotic state in these patients have been proposed. Among them are a platelet activation receptor, C-type lectin-like receptor 2 (CLEC-2), and its endogenous ligand podoplanin, which are the focus of this review. CLEC-2 is almost specifically expressed in platelets/megakaryocytes in humans. A membrane protein, podoplanin is expressed in certain types of cancer cells, including squamous cell carcinoma, brain tumor, and osteosarcoma, in addition to several normal tissues, including kidney podocytes and lymphatic endothelial cells but not vascular endothelial cells. In the bloodstream, podoplanin induces platelet activation by binding to CLEC-2 and facilitates hematogenous cancer metastasis and cancer-associated thrombosis. In an experimental lung metastasis model, the pharmacological depletion of CLEC-2 from platelets in mice resulted in a marked reduction of lung metastasis of podoplanin-expressing B16F10 cells. Control mice with B16F10 orthotopically inoculated in the back skin showed massive thrombus formation in the lungs, but the cancer-associated thrombus formation in CLEC-2-depleted mice was significantly inhibited, suggesting that CLEC-2-podoplanin interaction stimulates cancer-associated thrombosis. Thromboinflammation induced ectopic podoplanin expression in vascular endothelial cells or macrophages, which may also contribute to cancer-associated thrombosis. CLEC-2 depletion in cancer-bearing mice resulted in not only reduced cancer-associated thrombosis but also reduced levels of plasma inflammatory cytokines, anemia, and sarcopenia, suggesting that cancer-associated thrombosis may cause thromboinflammation and cancer cachexia. Blocking CLEC-2-podoplanin interaction may be a novel therapeutic strategy in patients with podoplanin-expressing cancer.
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Affiliation(s)
- Katsue Suzuki-Inoue
- Department of Clinical and Laboratory Medicine, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi, Japan
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28
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Mou Y, Li M, Hou S, Ren X, Tian B. Assessment of preoperative hypercoagulability in patients with pancreatic ductal adenocarcinoma (PDAC) using rapid thromboelastography (r-TEG). J Thromb Thrombolysis 2019; 48:648-652. [PMID: 31250338 DOI: 10.1007/s11239-019-01908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patients with malignant tumors are usually accompanied with hypercoagulability state and high incidence risk of venous thromboembolism (VTE), especially in patients with pancreatic ductal adenocarcinoma (PDAC). However, conventional coagulation test is failed to identify this abnormity. We retrospectively reviewed clinical data of 78 PDAC patients and 79 age-matched controls with rapid thromboelastography (r-TEG) and conventional coagulation test. The main index of r-TEG include TEG-ACT (second), R (second), K (second), angleα (°) and MA (mm), and a short TEG-ACT, short R, a short K, a broad angleα and a prolonged MA can identify hypercoagulability. Compared with age-matched controls, the PADC patients were analyzed to have a shorter K value (72. + 24 ± 22.90 vs. 85.63 ± 32.81, P = 0.0014), increased angleα value (76.20 ± 3.68 vs. 74.415 ± 4.73, P = 0.009) and MA value (63.33 ± 7.19 vs. 60.89 ± 5.52, P = 0.18). Both TEG-ACT (101.72 ± 7.57 vs. 103.78 ± 7.33, P = 0.086) and R (32.95 ± 4.72 vs. 34.34 ± 4.61, P = 0.085) value showed no significant difference in two groups. The laboratory values for conventional coagulation test were within normal ranges: PT (11.65 ± 0.95 vs. 11.38 ± 0.79, P = 0.049), INR (1.01 ± 0.09 vs. 0.98 ± 0.08, P = 0.101), aPTT (28.75 ± 3.45 vs. 28.00 ± 2.98, P = 0.149) and TT (19.44 ± 1.12 vs. 19.69 ± 1.35, P = 0.212). Incidence rates of VTE were 3.8% (3 of 78 patients) and 1.3% (1 of 79 patients) respectively (Fisher's exact test: P = 0.367). Several r-TEG indexes can indicate coagulation disorders within PDAC patients, but the incidence rates of VTE for both PDAC patients and normal controls had no significant difference. Compare to the control group, the potential hypercoagulability of PDAC patients did not correlate to thrombotic complications.
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Affiliation(s)
- Yu Mou
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Mao Li
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Shengzhong Hou
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Xue Ren
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, China
| | - Bole Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan Province, China.
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29
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Ha J, Lee MJ, Kim SJ, Park BY, Park H, Cho S, Chung JW, Seo WK, Kim GM, Bang OY, Chung CS. Prevalence and Impact of Venous and Arterial Thromboembolism in Patients With Embolic Stroke of Undetermined Source With or Without Active Cancer. J Am Heart Assoc 2019; 8:e013215. [PMID: 31640456 PMCID: PMC6898837 DOI: 10.1161/jaha.119.013215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background An increased risk of acute ischemic stroke is recognized among patients with cancer. However, the mechanism behind cancer‐related stroke is unclear. In this study, we determined the presence of associated venous thromboembolism and arterial thromboembolism and their clinical impact on patients with cancer‐related stroke. Methods and Results Patients with embolic stroke of undetermined source with or without cancer were evaluated for venous thromboembolism (deep vein thrombosis [DVT] and/or pulmonary embolism) and arterial thromboembolism by using Doppler sonography to determine the presence of lower‐extremity DVT and the microembolic signal of the symptomatic cerebral circulation, respectively. Infarct volume was determined by diffusion‐weighted magnetic resonance imaging. The multivariable linear regression and Cox proportional hazard analysis were used to investigate the effect of DVT and microembolic signal on infarct volume and 1‐year survival, respectively. Of 142 screened patients, 118 were included (37 with, 81 without cancer). Those with cancer had a higher prevalence of DVT or microembolic signal than did the noncancer group (62.2% versus 19.8%; P<0.001). Among patients with cancer‐related stroke, DVT was associated with a greater infarct volume in magnetic resonance imaging (beta, 13.14; 95% CI, 1.62–24.66; P=0.028). Presence of DVT (hazard ratio, 16.79; 95% CI, 2.05–137.75; P=0.009) and microembolic signal (hazard ratio, 8.16; 95% CI, 1.36–48.85; P=0.022) were independent predictors of poor 1‐year survival. Conclusions Patients with cancer‐associated embolic stroke of undetermined source have an elevated risk of associated venous thromboembolism and arterial thromboembolism, both of which have a significant negative impact on 1‐year survival. The results of this study may enhance our understanding of cancer‐associated stroke and improve risk stratification of patients with this disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov/.Unique identifier: NCT02212496
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Affiliation(s)
- Jongmok Ha
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Mi Ji Lee
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Suk Jae Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Bo-Yong Park
- Department of Electronic Electrical and Computer Engineering Sungkyunkwan University Suwon Republic of Korea.,Center for Neuroscience Imaging Research Institute for Basic Science (IBS) Suwon Republic of Korea
| | - Hyunjin Park
- Center for Neuroscience Imaging Research Institute for Basic Science (IBS) Suwon Republic of Korea.,School of Electronic and Electrical Engineering Suwon Republic of Korea
| | - Soohyun Cho
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Chin-Sang Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Republic of Korea
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30
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Hua X, Han SH, Wei SZ, Wu Y, Sha J, Zhu XL. Clinical features of pulmonary embolism in patients with lung cancer: A meta-analysis. PLoS One 2019; 14:e0223230. [PMID: 31568496 PMCID: PMC6768482 DOI: 10.1371/journal.pone.0223230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/17/2019] [Indexed: 12/21/2022] Open
Abstract
Background Pulmonary embolism (PE) is correlated with increased mortality among patients with lung cancer (LC). The characteristics of patients with LC presenting with PE have not been fully established, and our meta-analysis aims to comprehensively investigate the clinical characteristics associated with PE in patients with LC to help physicians identify PE earlier in these patients. Methods Multiple databases were searched, including PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure and Wanfang. Odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (95% CIs) were used as effect measures for dichotomous and continuous variables, respectively. Moreover, Egger’s test, Begg’s test and a sensitivity analysis were performed to assess the publication bias and reliability of the articles. Results In total, 16 studies were included in our meta-analysis. The results indicated that history of chronic obstructive pulmonary disease (OR = 2.59, 95% CI: 1.09, 6.15; P = 0.03), adenocarcinoma (OR = 2.28, 95% CI: 1.88, 2.77; P < 0.01), advanced tumour stage (TNM III-IV vs. I-II, OR = 2.38, 95% CI: 1.99, 2.86; P < 0.01), history of central venous catheter (OR = 1.95, 95% CI: 1.36, 2.78; P < 0.01), history of chemotherapy (OR = 2.32, 95% CI: 1.80, 2.99, P < 0.01), high levels of D-dimer (WMD = 4.31, 95% CI: 2.53, 6.10; P < 0.01) and carcinoembryonic antigen (WMD = 10.30, 95% CI: 9.95, 10.64; P < 0.01) and a low level of partial pressure of oxygen (WMD = -25.97, 95% CI: -31.31, -20.62; P < 0.01) were clinical features of LC patients with PE compared to those without PE. Conclusions These results reveal that LC patients with PE have specific clinical features, including but not limited to several cancer- and treatment-related factors, that may help their early identification.
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Affiliation(s)
- Xin Hua
- Department of Respiratory, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
- Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Shu-Hua Han
- Department of Respiratory, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
- Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Shu-Zhen Wei
- Department of Respiratory, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Ying Wu
- Department of Respiratory, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
| | - Jun Sha
- Department of Respiratory, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
- Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Xiao-Li Zhu
- Department of Respiratory, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
- Medical School of Southeast University, Nanjing, Jiangsu, China
- * E-mail:
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31
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Stoyanov GS, Dzhenkov DL, Tzaneva M. Thrombophlebitis Migrans (Trousseau Syndrome) in Pancreatic Adenocarcinoma: An Autopsy Report. Cureus 2019; 11:e5528. [PMID: 31687303 PMCID: PMC6819058 DOI: 10.7759/cureus.5528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
First described by a French physician Armand Trousseau, the Trousseau sign of malignancy is a classic example of paraneoplastic syndrome, caused by adenocarcinomas predominantly of the stomach, pancreas, and lung. The condition presents as recurring and migrating episodes of thrombophlebitis that can involve the upper and lower limbs, thoracic and abdominal wall, and the major blood vessels of the abdomen. These recurring episodes may lead to a detachment of a thrombus and the formation of pulmonary thromboembolism (PTE), often proving fatal for the patient. Herein we present a case of a 60-year-old male patient referred for autopsy. The patient was admitted with acute onset of gastrointestinal tract symptoms and after admission, his condition deteriorated rapidly, with new-onset neurological symptoms and an acute massive fatal episode of PTE. Previous medical history was uneventful, apart from several episodes of recurring lower limb thrombophlebitis for the past six months, resulting in two prior episodes of PTE. The autopsy revealed a massive PTE, with multiple thrombi in the venous vessels, including the two common iliac veins and the inferior vena cava. Histological evaluation revealed pancreatic adenocarcinoma with distant metastasis to a number of organs and abdominal thrombophlebitis with embolization of the pulmonary arteries.
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Affiliation(s)
| | - Deyan L Dzhenkov
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | - Maria Tzaneva
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
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32
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Siriratnam P, Kraemer T, Sahathevan R. Stroke in malignancy: complexities of diagnosis and management: a case report. J Med Case Rep 2019; 13:260. [PMID: 31426851 PMCID: PMC6701109 DOI: 10.1186/s13256-019-2183-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is an established association between cancer and stroke, the role of malignancy as a causative agent or comorbidity is not always clear. Moreover, there are no established guidelines on the acute treatment of cancer-associated stroke or optimal anticoagulation. This case report illustrates the significance of these practice gaps. CASE PRESENTATION A 62-year-old Caucasian woman presented to our institute with acute neurological deficits and was found to have an occluded left middle cerebral artery on a computed tomographic angiogram. She was administered intravenous alteplase and underwent unsuccessful endovascular clot retrieval. Besides smoking and her age, she had no cerebrovascular risk factors, and the results of baseline investigations for the cause of stroke were negative. Subsequent computed tomography of the chest, abdomen, and pelvis showed metastatic malignancy, and in the context of a significantly elevated serum cancer antigen 19-9, we suspected a pancreatic primary cancer. A transthoracic echocardiogram demonstrated mitral regurgitation but no visible vegetation. The patient died of her illness. We made a diagnosis of cancer-associated stroke, specifically a likely case of nonbacterial thrombotic endocarditis. CONCLUSIONS This case highlights the importance of having a high threshold of suspicion for malignancy as a cause of stroke.
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Affiliation(s)
- Pakeeran Siriratnam
- 0000 0004 0637 6869grid.414183.bBallarat Health Services, 1 Drummond Street North, Ballarat, Victoria 3350 Australia
| | - Thomas Kraemer
- 0000 0004 0637 6869grid.414183.bBallarat Health Services, 1 Drummond Street North, Ballarat, Victoria 3350 Australia ,0000 0001 0526 7079grid.1021.2Deakin University, Geelong, Victoria Australia
| | - Ramesh Sahathevan
- 0000 0004 0637 6869grid.414183.bBallarat Health Services, 1 Drummond Street North, Ballarat, Victoria 3350 Australia ,0000 0001 2179 088Xgrid.1008.9University of Melbourne, Melbourne, Victoria Australia ,0000 0004 0606 5526grid.418025.aFlorey Institute, Parkville, Victoria Australia
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33
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[Clinical analysis of disseminated intravascular coagulation in 6 patients with hematological diseases after CAR-T treatment]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:422-425. [PMID: 31207709 PMCID: PMC7342225 DOI: 10.3760/cma.j.issn.0253-2727.2019.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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34
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The relationship between pancreatic cancer and hypercoagulability: a comprehensive review on epidemiological and biological issues. Br J Cancer 2019; 121:359-371. [PMID: 31327867 PMCID: PMC6738049 DOI: 10.1038/s41416-019-0510-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
It has long been recognised that pancreatic cancer induces a hypercoagulable state that may lead to clinically apparent thrombosis. Although the relationship between pancreatic cancer and hypercoagulability is well described, the underlying pathological mechanism(s) and the interplay between these pathways remain a matter of intensive study. This review summarises existing data on epidemiology and pathogenesis of thrombotic complications in pancreatic cancer with a particular emphasis on novel pathophysiological pathways. Pancreatic cancer is characterised by high tumoural expression of tissue factor, activation of leukocytes with the release of neutrophil extracellular traps, the dissemination of tumour-derived microvesicles that promote hypercoagulability and increased platelet activation. Furthermore, other coagulation pathways probably contribute to these processes, such as those that involve heparanase, podoplanin and hypofibrinolysis. In the era in which heparin and its derivatives—the currently recommended therapy for cancer-associated thrombosis—might be superseded by direct oral anticoagulants, novel data from mouse models of cancer-associated thrombosis suggest the possibility of future personalised therapeutic approaches. In this dynamic era for cancer-associated thrombosis, the discovery of novel prothrombotic and proinflammatory mechanisms will potentially uncover pharmacological targets to prevent and treat thrombosis without adversely affecting haemostasis.
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35
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Oyakawa T, Fukuda H, Muraoka N, Iida K, Kusuhara M. Cancer-associated cerebral infarction during direct oral anticoagulant treatment in cancer patients: a case series. Int Cancer Conf J 2019; 8:130-135. [PMID: 31218190 DOI: 10.1007/s13691-019-00370-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/12/2019] [Indexed: 11/24/2022] Open
Abstract
The effect of direct oral anticoagulants (DOACs) on cancer-associated cerebral infarction (CI) is unclear. We present the clinical course of 20 consecutive patients with cancer-associated CI that developed during treatment with DOACs. The incidence rate of cancer-associated CI during the treatment with DOACs was 3.4%. The median modified Rankin scale (mRS) and Karnofsky performance status (KPS) after CI were 5 and 30, respectively. The median survival time after CI was 1 month. In the group in which the thrombus due to venous thromboembolism (VTE) was reduced before CI, the median mRS, KPS, and prognosis after CI were significantly better than in those of the group with unchanged thrombus. Cancer-associated CI also developed in patients taking DOACs and those who did not show VTE recurrence. When the VTE thrombus decreased or disappeared with DOAC treatment, the clinical course after cancer-associated CI was improved.
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Affiliation(s)
- Takuya Oyakawa
- 1Division of Cardiology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
| | - Hiroyuki Fukuda
- 2Division of Neurology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Nao Muraoka
- 1Division of Cardiology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
| | - Kei Iida
- 1Division of Cardiology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
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Nakao S, Masuda T, Sakamoto S, Yamaguchi K, Horimasu Y, Miyamoto S, Nakashima T, Iwamoto H, Fujitaka K, Hamada H, Hattori N. Cerebral embolism during edoxaban administration for venous thromboembolism in a patient with lung adenocarcinoma: A case report. Medicine (Baltimore) 2019; 98:e14821. [PMID: 30896626 PMCID: PMC6709197 DOI: 10.1097/md.0000000000014821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
RATIONALE The efficacy of direct oral anticoagulants (DOACs) in the treatment and prophylaxis of cancer-related venous thromboembolism (VTE) is reportedly similar to that of heparin. However, the effect of DOACs on the prophylaxis of cancer-related arterial thromboembolism (ATE) remains unclear. To our knowledge, we present the 1st case where cerebral ATE was encountered during edoxaban administration for VTE in a patient with lung adenocarcinoma. PATIENT CONCERNS In March 2017, a 63-year-old female was diagnosed with lung adenocarcinoma (cT2aN3M1b stage IVa) along with having asymptomatic VTE; thus, 60 mg/day edoxaban administration was initiated. In addition, 1st-line chemotherapy generated a partial antitumoral response. However, owing to lung cancer progression, a secondary treatment with pembrolizumab administration was initiated. The patient suddenly experienced aphasia 11 days after pembrolizumab administration. DIAGNOSIS The patient was diagnosed as multiple cerebral ATE using brain magnetic resonance imaging. However, VTE recurrence was not observed. Based on the findings of lung cancer progression and increased coagulation, cerebral ATE was diagnosed as Trousseau syndrome. INTERVENTIONS DOAC administration was switched to heparin administration. OUTCOMES Coagulation profile normalized and aphasia improved without any further disease symptoms. LESSONS We considered that DOACs are effective for the treatment and prophylaxis of VTE but may be insufficient for ATE prevention. Therefore, DOACs should be replaced with heparin to prevent ATE when cancer and coagulation become uncontrollable with DOAC.
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Aoyama KI, Tamura M, Uchibori M, Nakanishi Y, Arai T, Aoki T, Osawa Y, Kaneko A, Ota Y. Trousseau syndrome in a patient with advanced oral squamous cell carcinoma: a case report. J Med Case Rep 2019; 13:26. [PMID: 30691539 PMCID: PMC6350311 DOI: 10.1186/s13256-018-1833-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background Trousseau syndrome is known as a variant of cancer-associated thrombosis. Trousseau syndrome commonly occurs in patients with lung or prostate cancer. Hypercoagulability is thought to be initiated by mucins produced by the adenocarcinoma, which react with leukocyte and platelet selectins to form platelet-rich microthrombi. This is the first report of Trousseau syndrome in a patient with oral cancer. Case presentation Here, we describe the case of a 61-year-old Japanese man diagnosed as having advanced buccal carcinoma (T4bN2bM1; the right scapula, erector spinae muscles, and the right femur), who experienced aphasia and loss of consciousness. Although magnetic resonance imaging showed cerebral infarction, carotid invasion by the tumor and carotid sheath rupturing, cardiovascular problems, and bacterial infection were not present, which indicated Trousseau syndrome. Conclusions Trousseau syndrome in oral cancer is rare, but we must always consider cancer-associated thrombosis in patients with advanced stages of cancer regardless of the primary site of the cancer and take steps to prevent it.
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Affiliation(s)
- Ken-Ichi Aoyama
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masashi Tamura
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Uchibori
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yasuhiro Nakanishi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshihiro Arai
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto, Shizuoka, 411-0905, Japan
| | - Takayuki Aoki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yuko Osawa
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Akihiro Kaneko
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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Impacts of Cancer on Platelet Production, Activation and Education and Mechanisms of Cancer-Associated Thrombosis. Cancers (Basel) 2018; 10:cancers10110441. [PMID: 30441823 PMCID: PMC6266827 DOI: 10.3390/cancers10110441] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/31/2018] [Accepted: 11/10/2018] [Indexed: 12/12/2022] Open
Abstract
Platelets are small anucleate cells that are traditionally described as the major effectors of hemostasis and thrombosis. However, increasing evidence indicates that platelets play several roles in the progression of malignancies and in cancer-associated thrombosis. A notable cross-communication exists between platelets and cancer cells. On one hand, cancer can “educate” platelets, influencing their RNA profiles, the numbers of circulating platelets and their activation states. On the other hand, tumor-educated platelets contain a plethora of active biomolecules, including platelet-specific and circulating ingested biomolecules, that are released upon platelet activation and participate in the progression of malignancy. The numerous mechanisms by which the primary tumor induces the production, activation and aggregation of platelets (also known as tumor cell induced platelet aggregation, or TCIPA) are directly related to the pro-thrombotic state of cancer patients. Moreover, the activation of platelets is critical for tumor growth and successful metastatic outbreak. The development or use of existing drugs targeting the activation of platelets, adhesive proteins responsible for cancer cell-platelet interactions and platelet agonists should be used to reduce cancer-associated thrombosis and tumor progression.
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Cancer-Associated Thrombosis: An Overview of Mechanisms, Risk Factors, and Treatment. Cancers (Basel) 2018; 10:cancers10100380. [PMID: 30314362 PMCID: PMC6209883 DOI: 10.3390/cancers10100380] [Citation(s) in RCA: 322] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 12/15/2022] Open
Abstract
Cancer-associated thrombosis is a major cause of mortality in cancer patients, the most common type being venous thromboembolism (VTE). Several risk factors for developing VTE also coexist with cancer patients, such as chemotherapy and immobilisation, contributing to the increased risk cancer patients have of developing VTE compared with non-cancer patients. Cancer cells are capable of activating the coagulation cascade and other prothrombotic properties of host cells, and many anticancer treatments themselves are being described as additional mechanisms for promoting VTE. This review will give an overview of the main thrombotic complications in cancer patients and outline the risk factors for cancer patients developing cancer-associated thrombosis, focusing on VTE as it is the most common complication observed in cancer patients. The multiple mechanisms involved in cancer-associated thrombosis, including the role of anticancer drugs, and a brief outline of the current treatment for cancer-associated thrombosis will also be discussed.
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Okazaki K, Oka F, Ishihara H, Suzuki M. Cerebral infarction associated with benign mucin-producing adenomyosis: report of two cases. BMC Neurol 2018; 18:166. [PMID: 30286732 PMCID: PMC6171147 DOI: 10.1186/s12883-018-1169-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cerebral infarction associated with a malignant tumor is widely recognized as Trousseau syndrome. In contrast, few cases of cerebral infarction associated with benign tumors have been reported. We present two cases of embolic stroke that seemed to be caused by mucin-producing adenomyosis. CASE PRESENTATION The patients were women aged 42 and 50 years old. Both patients developed right hemiparesis and aphasia, and cerebral infarctions were detected in the left cerebral hemisphere. There were no other abnormal findings, except for elevation of CA125 and D-dimer. Trousseau syndrome was suspected in both cases, but whole body examinations did not reveal any malignant tumors. However, uterine adenomyosis was detected in both patients. CONCLUSIONS From our findings and a review of the literature, both mucin-producing malignant tumors and mucin-producing benign tumors such as adenomyosis may cause hypercoagulability and cerebral infarction. This mechanism should be considered in a case of a young to middle-aged woman with embolic stroke of an undetermined origin.
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Affiliation(s)
- Koki Okazaki
- Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Fumiaki Oka
- Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
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Soga Y, Taira K, Sugimoto A, Kurosawa M, Kira H, Su T, Doi K, Nakano A, Himura Y. Mitral valve nonbacterial thrombotic endocarditis: a rare multi-surgery-tolerant survivor of Trousseau's syndrome. Surg Case Rep 2018; 4:104. [PMID: 30159818 PMCID: PMC6115325 DOI: 10.1186/s40792-018-0513-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few previous reports have documented cases of nonbacterial thrombotic endocarditis associated with Trousseau's syndrome for which surgery proved possible for both the primary tumor and the cardiac lesion. The effectiveness of direct oral anticoagulants in patients with Trousseau's syndrome has also received scant attention. CASE PRESENTATION A 69-year-old man with repeated episodes of cerebral infarction was diagnosed as having nonbacterial thrombotic endocarditis after mitral valve replacement surgery. Stroke recurred preoperatively under apixaban administration. A stomach biopsy also identified gastric adenocarcinoma, and gastric surgery was performed on the 40th postoperative day. The patient was discharged from the hospital and has been free of thromboembolism under a regime of subcutaneous heparin self-injection thereafter. CONCLUSIONS We have reported a rare multi-surgery-tolerant survivor of Trousseau's syndrome in whom subcutaneous heparin injection was useful for preventing thromboembolic events over a long period.
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Affiliation(s)
- Yoshiharu Soga
- Department of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan.
| | - Kaoru Taira
- Department of Surgery, Nagahama City Hospital, Nagahama, Japan
| | - Akira Sugimoto
- Department of Cardiology, Hikone Municipal Hospital, 1882 Yasaka-cho, Hikone, Shiga, 522-8539, Japan
| | - Manabu Kurosawa
- Department of Pathology, Nagahama City Hospital, 313 Oh-inui-cho, Nagahama, Shiga, 526-8580, Japan
| | - Hiromasa Kira
- Department of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan
| | - Takamitsu Su
- Department of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan
| | - Kazuhiko Doi
- Department of Cardiovascular Surgery, Nagahama City Hospital, Nagahama, Japan
| | - Akira Nakano
- Department of Cardiology, Hikone Municipal Hospital, 1882 Yasaka-cho, Hikone, Shiga, 522-8539, Japan
| | - Yoshihiro Himura
- Department of Cardiology, Hikone Municipal Hospital, 1882 Yasaka-cho, Hikone, Shiga, 522-8539, Japan
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Abdel-Razeq H, Mansour A. Venous thromboembolism prophylaxis for ambulatory cancer patients, can we do better? J Thromb Thrombolysis 2018; 44:399-405. [PMID: 28861758 DOI: 10.1007/s11239-017-1542-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with cancer are at a much higher risk of thromboembolic events. Such events are occasionally associated with significant complications that can negatively affect patients' quality of life. Thromboprophylaxis is widely practiced, but much of the emphasis is given for those admitted with acute medical illnesses or following major surgical procedures. However, a significant percentage of thrombotic events encountered in routine clinical practice are among ambulatory patients where current guidelines do not recommend routine thromboprophylaxis.
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Affiliation(s)
- Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center and School of Medicine, University of Jordan, Amman, Jordan.
| | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
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Nonagase Y, Takeda M, Tanaka K, Hayashi H, Iwasa T, Nakagawa K. Treatment of EGFR mutation-positive non-small cell lung cancer complicated by Trousseau syndrome with gefitinib followed by osimertinib: a case report. Oncotarget 2018; 9:29532-29535. [PMID: 30034636 PMCID: PMC6047674 DOI: 10.18632/oncotarget.25687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/13/2018] [Indexed: 11/25/2022] Open
Abstract
Malignant tumors can induce a hypercoagulable state known as Trousseau syndrome that increases the risk for venous thromboembolism including disabling cerebral infarction. Anticoagulant therapy without anticancer treatment is not effective for amelioration of this coagulation abnormality. Most patients with lung cancer positive for activating mutations of the epidermal growth factor receptor (EGFR) are sensitive to EGFR tyrosine kinase inhibitors (TKIs), but the efficacy and safety of EGFR-TKIs in such patients with a poor performance status (PS) due to Trousseau syndrome has been unclear. We here describe a patient with EGFR mutation-positive lung cancer who developed disabling cerebral infarction due to Trousseau syndrome. Administration of the EGFR-TKI gefitinib and anticoagulant therapy resulted in a partial tumor response and recovery from both the coagulation abnormality and the severe neurological symptoms. After the development of resistance to gefitinib, the EGFR-TKI osimertinib was safely administered until disease progression without recurrence of the coagulation abnormality. This case suggests that gefitinib followed by osimertinib may be a safe and effective treatment option for patients with EGFR mutation-positive lung cancer who experience disabling cerebral infarction due to Trousseau syndrome.
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Affiliation(s)
- Yoshikane Nonagase
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hidetoshi Hayashi
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tsutomu Iwasa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka, Japan
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Bednarska K, Klink M, Sułowska Z, Król E, Głowacka E, Romanowicz H, Nowak M, Szyłło K. Analysis of preoperative blood platelet parameters in terms of diversity of epithelial ovarian cancer. Medicine (Baltimore) 2018; 97:e0180. [PMID: 29561432 PMCID: PMC5895358 DOI: 10.1097/md.0000000000010180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Smouldering inflammation, thrombocytosis, and platelet hyper-reactivity are linked to malignancy. The relationships between preoperative diagnostic blood morphology parameters and cancer have been the focus of much interest, because some of these parameters are correlated with advanced cancer stages and poor patient survival rates. This study aimed to perform an observational, retrospective analysis of the intradiversity of blood platelet parameters in patients with different International Federation of Gynaecology and Obstetrics (FIGO) stages and different histological types of epithelial ovarian carcinomas (EOC), and also an analysis of the overall survival rate.In all, 94 EOC patients were included in this analysis (23 mucinous, 33 serous, 20 undifferentiated, 14 endometrioid, and 4 clear cell carcinoma cases). Peripheral blood samples were collected and analyzed before drug or surgical treatment.The platelet-to-neutrophil ratio (PNR) was related to the histological type of EOC, particularly mucinous carcinoma. In patients with mucinous cancer, the PNR was significantly lower compared with patients with nonmucinous cancer, and this parameter distinguished between mucinous and nonmucinous groups of patients (area under receiver-operating characteristic [ROC] curve 0.721 ± .056; sensitivity 82.6%; specificity 61%; P < .001; ROC analysis), regardless of the FIGO stage. Moreover, elevated PNR values were correlated with lower survival rate of EOC patients.The reduced PNR, similar to the lower level of cancer antigen 125, is characteristic for mucinous ovarian carcinoma patients. Moreover, elevated PNR index might correlate with poor survival of patients.
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Affiliation(s)
- Katarzyna Bednarska
- Department of Experimental Immunology, Institute of Medical Biology of Polish Academy of Sciences
| | - Magdalena Klink
- Department of Experimental Immunology, Institute of Medical Biology of Polish Academy of Sciences
| | - Zofia Sułowska
- Department of Experimental Immunology, Institute of Medical Biology of Polish Academy of Sciences
| | - Ewa Król
- Medical Centre of Laboratory Diagnostics and Screening Tests, Polish Mother's Memorial Hospital Research Institute
| | - Ewa Głowacka
- Medical Centre of Laboratory Diagnostics and Screening Tests, Polish Mother's Memorial Hospital Research Institute
| | | | - Marek Nowak
- Department of Operative Gynaecology and Gynaecological Oncology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Krzysztof Szyłło
- Department of Operative Gynaecology and Gynaecological Oncology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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Kayukawa S, Ina K, Furuta R, Nishio T, Miyashita T, Umeda S, Kataoka T. Bladder squamous cell cancer accompanied by Trousseau's syndrome: a case report. Clin Case Rep 2018; 6:653-657. [PMID: 29636934 PMCID: PMC5889235 DOI: 10.1002/ccr3.1433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 12/21/2022] Open
Abstract
The association between thrombosis and cancer has been recognized since Trousseau's report in 1865. We present a case of bladder squamous cell carcinoma associated with multiple cerebral infarctions. This patient was diagnosed as having Trousseau's syndrome and received radiotherapy for bladder cancer treatment, along with anticoagulation therapy.
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Affiliation(s)
- Satoshi Kayukawa
- Department of Clinical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Kenji Ina
- Department of Medical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Ryuichi Furuta
- Department of Medical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Tomoko Nishio
- Department of Pathology Nagoya Memorial Hospital Nagoya Japan
| | | | - Shun Umeda
- Department of Urology Nagoya Memorial Hospital Nagoya Japan
| | - Takae Kataoka
- Department of Clinical Oncology Nagoya Memorial Hospital Nagoya Japan
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The Interaction of Selectins and PSGL-1 as a Key Component in Thrombus Formation and Cancer Progression. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6138145. [PMID: 28680883 PMCID: PMC5478826 DOI: 10.1155/2017/6138145] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 12/11/2022]
Abstract
Cellular interaction is inevitable in the pathomechanism of human disease. Formation of heterotypic cellular aggregates, between distinct cells of hematopoietic and nonhematopoietic origin, may be involved in events leading to inflammation and the complex process of cancer progression. Among adhesion receptors, the family of selectins with their ligands have been considered as one of the major contributors to cell-cell interactions. Consequently, the inhibition of the interplay between selectins and their ligands may have potential therapeutic benefits. In this review, we focus on the current evidence on the selectins as crucial modulators of inflammatory, thrombotic, and malignant disorders. Knowing that there is promiscuity in selectin binding, we outline the importance of a key protein that serves as a ligand for all selectins. This dimeric mucin, the P-selectin glycoprotein ligand 1 (PSGL-1), has emerged as a major player in inflammation, thrombus, and cancer development. We discuss the interaction of PSGL-1 with various selectins in physiological and pathological processes with particular emphasis on mechanisms that lead to severe disease.
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47
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Zalatnai A, Perjési E, Galambos E. Much More than Trousseau Syndrome. The Broad Spectrum of the Pancreatic Paraneoplastic Syndromes. Pathol Oncol Res 2017; 24:1-10. [PMID: 28160197 DOI: 10.1007/s12253-017-0206-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 01/24/2017] [Indexed: 11/28/2022]
Abstract
When 150 years ago Armand Trousseau proposed that some thrombotic events might be the first sign of concealed visceral malignancies, these findings seemed to be just of anecdotal interest. Since then, however, we have learned that adenocarcinomas, including pancreatic cancers could be associated with a wide spectrum of paraneoplastic syndromes. They may precede the detection of the tumor, may occur simultaneously or may develop during its progression. Due to various hematologic, endocrine, cutaneous, articular, neuromuscular, renal or even psychiatric syndromes, their correct interpretation is intriguing, and because their early signs are not necessarily recognized first by oncologists, the paraneoplastic syndromes pose a diagnostic challenge. Unfortunately, we cannot generalize about their mechanisms, because the molecular backgrounds are far-reaching. In most of the cases, the pancreatic cancer cells release various factors into the bloodstream triggering the coagulation cascade. These patients frequently present with venous thromboembolism, and sometimes they are resistant to anticoagulation. The simultaneous thrombotic and bleeding evens do reflect the abnormal hemostasis. In other instances autoantibodies are formed against cutaneous, renal, neuromuscular or nervous tissues, but the mechanism of some syndromes remains unclear. Clinicians should be aware that pancreatic carcinoma may be associated with not just the Trousseau-syndrome.
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Affiliation(s)
- Attila Zalatnai
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary.
| | - Eszter Perjési
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary
| | - Eszter Galambos
- First Department of Pathology and Experimental Cancer Research, Faculty of Medicine, Semmelweis University, H-1085 Üllői út 26, Budapest, Hungary
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Kuwahata S, Takenaka T, Yasuda S, Sakoda T, Taniyama H, Nagata Y, Iwakawa J, Matsumoto S, Seto T, Takenoyama M, Abe S, Ohishi M. A case of anticoagulant treatment-resistant Trousseau syndrome controlled by treatment of the underlying lung adenocarcinoma: Utility of monitoring D-dimer levels. J Cardiol Cases 2016; 15:65-69. [PMID: 30546699 DOI: 10.1016/j.jccase.2016.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/04/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022] Open
Abstract
We report herein a 70-year-old woman, with repeated thromboembolic events, including three cerebral embolisms and two venous thromboembolisms, despite adequate anticoagulant therapy. Trousseau syndrome was suspected, and she was diagnosed as having lung adenocarcinoma. Chemoradiotherapy was started, achieving improvements in the lung cancer, and thrombosis was also brought under control. Ten months later, the lung cancer relapsed, and second-line chemotherapy was performed. D-dimer levels, which had normalized after the first-line therapy, increased together with the relapse, but became negative again following the chemotherapy. In general, the prognosis of Trousseau syndrome is diverse. However, in this case, the course was good following the second lung cancer therapy: D-dimer levels did not increase, and there were no recurrences of thromboembolism. This experience reminds us the prognosis is most affected by whether the underlying disease is being effectively treated, and suggests that for Trousseau syndrome, despite adequate anticoagulant therapy, elevation of D-dimer levels should consider the recurrent cancer. <Learning objective: We report herein a case with repeated thromboembolic events as a result of Trousseau syndrome due to lung cancer. Chemotherapy achieved improvements, but the cancer relapsed and second-line chemotherapy was done. D-dimer levels, which had normalized, increased with the relapse before again becoming negative. This experience reminds us that prognosis is affected by treating underlying disease and suggests that elevation of D-dimer levels should consider the cancer recurrence.>.
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Affiliation(s)
- So Kuwahata
- Department of Internal and Cardiovascular Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Toshihiro Takenaka
- Department of Internal and Cardiovascular Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Shunsuke Yasuda
- Department of Internal and Cardiovascular Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Takashi Sakoda
- Department of Internal and Cardiovascular Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Hiroki Taniyama
- Department of Internal and Cardiovascular Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Yukitaka Nagata
- Department of Radiology, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Jun Iwakawa
- Department of Respiratory Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Takashi Seto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Mitsuhiro Takenoyama
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Satoshi Abe
- Department of Internal and Cardiovascular Medicine, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Abstract
Metastasis in lung cancer is a multifaceted process. In this review, we will dissect the process in several isolated steps such as angiogenesis, hypoxia, circulation, and establishment of a metastatic focus. In reality, several of these processes overlap and occur even simultaneously, but such a presentation would be unreadable. Metastasis requires cell migration toward higher oxygen tension, which is based on changing the structure of the cell (epithelial-mesenchymal transition), orientation within the stroma and stroma interaction, and communication with the immune system to avoid attack. Once in the blood stream, cells have to survive trapping by the coagulation system, to survive shear stress in small blood vessels, and to find the right location for extravasation. Once outside in the metastatic locus, tumor cells have to learn the communication with the “foreign” stroma cells to establish vascular supply and again express molecules, which induce immune tolerance.
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Kato T, Yasuda K, Iida H, Watanabe A, Fujiuchi Y, Miwa S, Imura J, Komiya A. Trousseau's syndrome caused by bladder cancer producing granulocyte colony-stimulating factor and parathyroid hormone-related protein: A case report. Oncol Lett 2016; 12:4214-4218. [PMID: 27895794 DOI: 10.3892/ol.2016.5152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/02/2016] [Indexed: 11/05/2022] Open
Abstract
The present study reports a rare case of bladder cancer that caused Trousseau's syndrome, a malignancy-associated hypercoagulative state leading to venous or arterial thrombosis. A 38-year-old Japanese female patient experienced a sudden onset of visual field defects and lower limb weakness. Cerebral magnetic resonance imaging revealed multi-regional hypointense areas compatible with acute cerebral infarction. Despite the repeated administration of anticoagulant treatment with heparin, the condition could not be adequately controlled and thromboembolic events occasionally recurred. Several tumor markers, including carbohydrate antigen 19-9, cancer antigen 125, carcinoembryonic antigen, cytokeratin 19 fragment and squamous cell carcinoma antigen levels, were elevated. Consequently, computed tomography scans were performed, which revealed a massive bladder tumor with multiple bone and lymph node metastases. The patient also exhibited other paraneoplastic disorders, including leukocytosis due to granulocyte colony-stimulating factor (G-CSF) production, and hypercalcemia due to parathyroid hormone-related protein (PTHrP) production. Transurethral resection of the bladder tumor was performed, and the tumor was pathologically confirmed as urothelial cell carcinoma. Immunohistochemical testing revealed positive staining for G-CSF and PTHrP. Despite undergoing gemcitabine/cisplatin-based systemic chemotherapy, the disease developed rapidly and the patient succumbed to the disease within 3 months of initial symptoms. The present case indicates that occult visceral malignancy should be considered in patients with unexplained thromboembolism.
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Affiliation(s)
- Tomonori Kato
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Kenji Yasuda
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Hiroaki Iida
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Akihiko Watanabe
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Yasuyoshi Fujiuchi
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Shigeharu Miwa
- Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Johji Imura
- Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
| | - Akira Komiya
- Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama 930-0194, Japan
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