Personalized and Precision Medicine Journal
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Metastatic Malignancy Presenting as Thrombotic Thrombocytopenia Purpura; Report of Two Cases

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

https://doi.org/10.22034/pmj.2023.702079
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

Thrombocytopenia
Gastric cancer
Thrombotic microangiopathy
Breast cancer
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Personalized and Precision Medicine Journal
Volume 8, Issue 28 - Serial Number 28
Original article
Winter 2023
Pages 1-4

  • Receive Date 09 December 2022
  • Revise Date 25 January 2023
  • Accept Date 10 February 2023

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