Espírito Santo Joana, Coutinho Inês, Pimentel Ana, Garcia Rui, Marques Dos Santos Rui
Internal Medicine Department A, University Hospital Center of Coimbra, 3000-075 Coimbra, Portugal.
General Surgery Department B, University Hospital Center of Coimbra, 3000-075 Coimbra, Portugal.
Case Rep Oncol Med. 2015;2015:345804. doi: 10.1155/2015/345804. Epub 2015 Feb 25.
Introduction. Superior vena cava (SVC) syndrome results from the obstruction of blood flow through the SVC, having distinct pathophysiological underlying mechanisms. Cancer is associated with an increased risk of thromboembolism that varies according to patient-, tumor-, and treatment-related factors. An individualized clinical approach is important to pursue the accurate diagnosis of the underlying pathology causing thromboembolism in cancer patients. Case Presentation. The authors present a case of a 58-year-old male with an infrequent presentation of an unknown colon carcinoma, who has never had any symptom until he was hospitalized with the diagnosis of superior vena cava syndrome and pulmonary thromboembolism. The patient had an advanced disease by the time of diagnosis and molecular alterations contributing to abnormal hemostasis. He presented venous and arterial thromboembolism and developed disseminated intravascular coagulopathy after surgery, anticoagulant and transfusion therapy, dying 40 days after the hospitalization. Conclusion. The authors discuss thromboembolic disease and tumor metastasis roles in a cancer patient with SVC syndrome. Thromboembolism in a malignancy context is a challenging clinical entity. A multifactorial perspective of the thrombotic disease is warranted to approach thromboembolism risk and stratify patients suitable to receive adequate anticoagulant prophylaxis and targeted therapies, aiming to improve clinical prognosis.
引言。上腔静脉（SVC）综合征是由于上腔静脉血流受阻所致，其病理生理机制各不相同。癌症与血栓栓塞风险增加相关，这种风险因患者、肿瘤和治疗相关因素而异。对于准确诊断癌症患者血栓栓塞背后的病理情况而言，个体化临床方法很重要。病例报告。作者报告一例58岁男性，患有罕见的不明结肠癌，在因上腔静脉综合征和肺血栓栓塞症住院之前从未出现过任何症状。该患者在诊断时已处于晚期疾病状态，且存在导致异常止血的分子改变。他出现了静脉和动脉血栓栓塞，并在手术、抗凝和输血治疗后发生了弥散性血管内凝血，住院40天后死亡。结论。作者讨论了血栓栓塞性疾病和肿瘤转移在一名患有上腔静脉综合征的癌症患者中的作用。恶性肿瘤背景下的血栓栓塞是一个具有挑战性的临床实体。有必要从多因素角度看待血栓形成疾病，以评估血栓栓塞风险并对适合接受充分抗凝预防和靶向治疗的患者进行分层，旨在改善临床预后。
