A Rare Case of Occipital Stroke as a Consequence of Nonbacterial Thrombotic Endocarditis in Ovarian Clear Cell Carcinoma: A Case Report

Abstract

Hypercoagulability occurs in 15% of patients with malignancy and represents a clinical spectrum ranging from abnormal coagulation tests but no clinically evident thromboembolic disease, to arterial and venous thrombosis, migratory thrombophlebitis, nonbacterial thrombotic endocarditis (NBTE) and disseminated intravascular coagulation. The combination of increased procoagulant activity and decreased fibrinolytic activity accelerates the prothrombotic potential of endothelial cells in malignancy. NBTE is a rare manifestation of cancer-induced hypercoagulability and is commonly seen with mucin-producing adenocarcinomas, but rarely seen with ovarian clear cell carcinoma (OCCC). Cerebrovascular embolization ranges from 14–91% in NBTE. We report a rare case of a 62-year-old female presenting with occipital stroke as a consequence of NBTE in OCCC. Association of NBTE in OCCC has only been reported in 2 cases so far, but presentation with stroke has never been reported in the literature.

Cerebral infarctions as manifestation of ovarian clear cell carcinoma: report of two cases and review of the literature

“…Although there was no clear pathological mechanism underlying the hypercoagulable state of a clear cell carcinoma, clear cell carcinoma may produce excessive levels of TF and is more likely to lead to the development of VTE [15]. Additionally, there were some reports about stroke due to NBTE associated with ovarian clear cell carcinoma [11,12]. Our cases are the first reported cases describing stroke as the first manifestation of ovarian clear cell carcinoma.…”

“…Stroke as well as VTE may be the first manifestation of ovarian cancer. Although there is no study about the incidence of cerebral infarction before the diagnosis of ovarian cancer, several reports show that cerebral infarctions in patients with ovarian cancer may be caused by nonbacterial thrombotic endocarditis or by a hypercoagulable state [8][9][10][11][12].…”

Rare and challenging case of stroke as a manifestation of non bacterial thrombotic endocarditis in an underlying ovarian clear cell carcinoma

“…A hypercoagulable state is commonly seen in mucin producing adenocarcinomas but very rarely found in ovarian clear cell carcinoma. 3 Only very few cases reported so far show an association between non bacterial thrombotic endocarditis and ovarian clear cell carcinoma.…”

Nonbacterial thrombotic endocarditis with embolic cerebral vascular accidents in a patient with advanced, recurrent clear cell carcinoma of the ovary: A case report

“…Nonbacterial thrombotic endocarditis (NBTE) is characterized by deposition of sterile platelet and fibrin thrombi on valvular structures, which are prone to embolism and most commonly involve the cerebrovascular circulation ( González et al, 1991 , Sørensen et al, 2000 ). NBTE is not uncommon in patients with advanced mucin-secreting ovarian adenocarcinomas, and a few case reports have shown an association with ovarian clear cell cancer (OCCC) ( Heit et al, 2000 , Aryana et al, 2006 , Devulapalli et al, 2012 , Naoi et al, 2013 ). In North America and Europe, OCCC is the second most common histologic subtype of epithelial ovarian cancer, with an estimated prevalence of 1–12% ( Goff et al, 1996 ).…”