Lung Adenocarcinoma Presenting as Multiple Thromboembolic Events: A Case Report and Review of the Literature

Abstract

Patients with malignancy may present with significant thromboembolic complications including deep vein thrombosis (DVT), pulmonary embolism, arterial thrombosis, nonbacterial thrombotic endocarditis, and stroke due to abnormal coagulation cascades. Although these events are typically recognized later in the disease process, complications of a hypercoagulable state can rarely present as the first manifestation of an occult malignancy. We report a case of a young male who was ultimately found to have an aggressive form of lung adenocarcinoma after the initial presentation of multiple thromboembolic events. DVT and stroke as an initial presentation of an active lung adenocarcinoma in a young patient is extremely rare as patients presenting in a hypercoagulable state usually are older. Though testing for a hypercoagulable state is not recommended for the first unprovoked DVT, clinicians should be prompted to screen for malignancy in the setting of cryptogenic strokes, especially in younger patients with no prior risk factors.

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

“…It may be speculated that although the imaging does not prove evidence of tumor, these patients may already have reginal lymph nodes or distant organs micrometastasis. In addition, previous researches implied that occult NSCLC often manifests as venous thromboembolism [ 10 , 11 ], which demonstrated that hematogenous metastasis occurred in this kind of NSCLC tumors. Undoubtedly, occult NSCLC had poor prognosis.…”

“…Therefore, more efficient screen method for example positron emission tomography-computed tomography (PET-CT) might contribute to early detection of primary tumor. Clinicians need to be vigilant when they encounter patients who manifest as internal diseases such as stroke [ 6 , 7 , 8 , 9 ], thromboembolism [ 10 , 11 ] and dermatomyositis [ 12 ]. As occult NSCLC might be the fundamental cause of these non-cancer-related symptoms, the more refined examinations should be performed as soon as possible.…”

“…Occult lung cancer, defined as the presence of malignant tumor cells in bronchial washing or sputum but demonstrated no tumor evidence by imaging [ 1 , 2 ], often manifests as metastasis diseases [ 3 , 4 , 5 ] or other internal diseases such as stroke [ 6 , 7 , 8 , 9 ], venous thromboembolism [ 10 , 11 ] and dermatomyositis [ 12 ]. When these patients develop apparent non-cancer-related symptoms, the vast majority may have already progressed to an advanced stage.…”

“…Owing to the ambiguous TNM stage, the prognosis of this subgroup disease is still an enigma, and elucidation of prognostic indicators is therefore necessary to define high-risk patients who may derive benefit from more intensive care. Following extensive literature review, due to the low incidence (about 0.53%) [ 8 ] and lack of tumor evidence by imaging [ 1 , 2 ], the number of related researches is still modest, and most of them are case reports [ 3 , 4 , 5 , 7 , 8 , 9 , 11 ]. The lack of clinical data makes the natural course of occult NSCLC far from understood and the establishment of corresponding therapeutic strategies impossible, and it also compromises efforts to define prognostic factors for occult NSCLC.…”

Recurrent Thromboembolic Events While on Anticoagulation Lead to the Diagnosis of Metastatic Lung Adenocarcinoma: A Case Report

“…As is true with most neoplasms, lung cancer can have a variety of adverse effects on the body, including hypercoagulability, which can lead to thromboembolic events such as pulmonary emboli (PE), deep vein thrombosis (DVT), ischemic strokes, and non-bacterial thrombotic endocarditis (NBTE) [1][2][3]. Hypercoagulability due to cancer is, in part, due to an imbalance between factors that drive coagulation and fibrinolysis [4].…”