Document Type : Case Study
Authors
- Hamid Rezvani 1
- Mehdi Tabarraee 2
- Mojtaba Ghadyani 2
- Seyed Amir Sheikholeslami 3
- Hamideh Rahmani 2
- Soude Ramezan Nejad 4
- Aida Iranpour 5
1 Associate professor, Department of Medical Oncology and hematology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Assistant professor, Department of Medical Oncology and hematology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Medical Oncology and hematology, Imam hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Hematology and Oncology fellowship, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Assistant professor, Iran university of medical sciences, Tehran, Iran
Abstract
Background
Cancer associated thrombotic microangiopathy (CA-TMA) is a rare diagnosis that while confronting a patient with evidence of microangiopathic hemolytic anemia and thrombocytopenia with normal ADAMTS13 enzyme activity, should be considered. Here we present two cases of cancer associated TMA; breast cancer and gastric cancer.
Case presentation
Case 1 was a 40-year-old man presented with abdominal pain, icterus and weight loss and laboratory tests revealed microangiopathic hemolytic anemia. He received 6 sessions of plasma exchange under diagnosis of thrombotic thrombocytopenic purpura. Bone marrow biopsy and immunohistochemistry revealed clusters of non-hematopoietic cells suggestive of gastrointestinal adenocarcinoma. Case 2 was a 51-year-old woman whose clinical history and laboratory tests were similar to case 1 except for a breast mass along with axillary lymphadenopathy. Bone marrow examination revealed clusters of non-hematopoietic cells and core needle biopsy revealed invasive lobular carcinoma.
Both patients were unresponsive to plasma exchange and case 1 unfortunately shortly died after diagnosis but case 2 is alive and survived after receiving chemotherapy.
Conclusion
Cancer associated TMA can rarely be seen as the first manifestation of a malignancy and causes a diagnostic dilemma for clinicians.The prognosis of CA-TMA is generally poor and initiatingchemotherapy is the only reliable treatment option.
Keywords
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