Kadikoylu Gurhan, Barutca Sabri, Tataroglu Canten, Kafkas Samet, Erpek Hakan, Meydan Nezih, Yavasoglu Irfan, Bolaman Zahit
Adnan Menderes University Medical Faculty, Division of Hematology, 09100 Aydin, Turkey.
Transfus Apher Sci. 2010 Feb;42(1):39-42. doi: 10.1016/j.transci.2009.10.010. Epub 2009 Nov 17.
Thrombotic microangiopathy occurs in 5-10% of patients with mucin-producing disseminated adenocarcinoma. A 28-year-old woman complained of fatigue, bone pain, and weight loss. There were pallor, icterus, and tenderness in the bones on physical examination. Microangiopathic hemolytic anemia, leukoerythroblastic picture, thrombocytopenia, and normal coagulation tests were detected. Thrombotic thrombocytopenic purpura (TTP) was diagnosed and therapeutic plasma exchange was performed on the patient. On day 5 a laparotomy had to be performed because of acute abdomen due to the rupture of a corpus hemorrhagicum follicle of an ovary. Signet ring cell adenocarcinoma stained with cytokeratin 7 and mucicarmine was seen on ovaries and bone marrow, after the pathological examination. The primary site of tumor could not be investigated, because of the patient's refusal. Although chemotherapy including cis-platinum, infusional 5-fluorouracil, and calcium leucovorin were administered in two courses, she died from respiratory failure. In conclusion, malignancy and bone marrow involvement should be considered when associated with leukoerythroblastic picture and TTP.
血栓性微血管病发生于5% - 10%的黏液分泌性播散性腺癌患者中。一名28岁女性主诉疲劳、骨痛和体重减轻。体格检查发现面色苍白、黄疸和骨骼压痛。检测到微血管病性溶血性贫血、幼粒 - 幼红细胞血象、血小板减少，凝血试验正常。诊断为血栓性血小板减少性紫癜（TTP），并对该患者进行了治疗性血浆置换。第5天，因卵巢卵泡血肿破裂导致急腹症，不得不进行剖腹手术。病理检查后，在卵巢和骨髓中发现了细胞角蛋白7和黏液卡红染色的印戒细胞腺癌。由于患者拒绝，无法对肿瘤的原发部位进行检查。尽管给予了包括顺铂、持续静脉输注5 - 氟尿嘧啶和亚叶酸钙在内的两个疗程化疗，但她最终死于呼吸衰竭。总之，当出现幼粒 - 幼红细胞血象和TTP时，应考虑恶性肿瘤和骨髓受累。
