See cancer as a trigger for deep vein thrombosis

See cancer as a trigger for deep vein thrombosis

Main messages

If no triggering event can be identified for a patient with deep vein thrombosis, the cause should be considered an unknown cancer. Rosemary Poulose and L. Christian Napp, MD, and others from the Hannover Medical School in Germany recalled this in a recent newspaper article. They told the medical history of a 72-year-old woman.

The patient’s story

The woman had been hospitalized for 3 months for paranoid schizophrenia. The authors reported that the patient refused subcutaneous thrombosis prophylaxis, which was indicated due to insufficient mobility. Three months after being admitted to the clinic, she complained of sudden pain and swelling in her right leg.

Results

  • Swelling of the entire lower leg and right foot, which has moved to a hard, non-mobile, space-occupying dorsal knee mass

  • Intact peripheral perfusion, motor function and sensory function

  • Slightly impaired right knee movement

  • Payr test and Meyer negative sign

  • Laboratory tests: High D-dimer (1.58 mg / L; normal value, 0 to 0.5 mg / L)

  • Ultrasound: space-occupying mass similar to a cyst in the right popliteal fossa

  • Duplex ultrasound: thrombosis of the right popliteal vein up to the middle third of the fibular veins

  • Thrombosis therapy: anticoagulant with subcutaneous tinzaparin and compression dressing, then switch to edoxaban after 5 days.

Further findings and diagnosis

  • Radiographic examination of the right knee joint: Popliteal soft tissue tumor with “popcorn-like” opacity, not clearly distinguishable from the posterior tibia on X-rays

  • CT with venous phase of the contrast medium: medullary continuity of the mass occupying the space and calcification of the neighboring chondroid matrix

Diagnosis: thrombosis of the popliteal vein and secondary degenerated cartilage exostosis (chondrosarcoma) of the tibia.

Therapy: surgical resection of the tumor; continuation of anticoagulant therapy started before the procedure.

Discussion

According to the authors, when thrombosis is diagnosed, a known malignancy is present in about 15% of cases and an unknown malignancy in about 3% -15% of cases. The most common cancers linked to a high risk of venous thromboembolism include malignant tumors of the brain, pancreas, lungs, and gastrointestinal tract.

The authors further explained that the guidelines of the Scientific Medical Societies Working Group recommend, “in addition to basic laboratory tests, an individual approach and initial completion of age- and sex-specific screening, where applicable, also including radiographs of the chest and abdominal ultrasound “.

Cartilage exostoses (osteochondromas) are benign bone tumors that can degenerate, which are then referred to as secondary chondrosarcomas. Poulose et al stated that chondrosarcomas account for approximately 20% of malignant bone tumors. There have been rare cases of chondrosarcomas that have infiltrated the vessels and metastasized, which can lead to thromboembolism.

This article was translated by Univadis Germany.

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