Mucinous malignancies, venous thrombosis and terminal endocarditis with emboli: A syndrome

Abstract

Sixteen definite cases of NBTE were found in a series of 6,459 autopsies. Eight of these cases had multiple large valvular vegetations; 4 had a single large vegetation and 4 disclosed multiple small vegetations. Seven of the 8 cases with the multiple large vegetations had mucus producing carcinoma, clinically significant infarctions of various organs due to emboli from the NBTE and clinical or autopsy evidence of peripheral venous thrombosis. This combination of clinicopathologic findings appears to constitute a definite, though uncommon syndrome, and retrospective review of the patients' charts suggests that it may be possible to establish this diagnosis during life.

Disseminated Intravascular Coagulation and Related Syndromes: A Clinical Review

“…Pulmonary hemorrhage is a very early and prominent sign of chronic DIC in the patient with cancer. 54,99 Approximately 75% of patients with cancer and chronic DIC will eventually develop clinical evidence of this syndrome and 25% will develop some type of significant thrombotic event. 1,2 As will be discussed under "Therapy," many patients with chronic DIC and cancer may show marked correction of both the clinical hemorrhage or thrombosis as well as labora tory findings of DIC when aggressive antineoplastic therapy is instituted.…”

Nonbacterial thrombotic endocarditis in cancer patients: Comparison of characteristics of patients with and without concomitant disseminated intravascular coagulation

“…No cases of leukemia were found in the earlier study reported from this institution [6]. A review of English medical literature indicates the incidence of NBTE in leukemic patients to be extremely rare; only one out of over 200 cases of NBTE, reported by four large autopsy review studies, was found to have leukemia [3,5,9,13] . The reason for the increase in the incidence of NBTE in patients with hematologic malignancies and solid tumors is unknown.…”

Thromboplastic and fibrinolytic activities of cultured human cancer cell lines

“…From the results of coagulation studies using standard, Factor VIIdeficient and Factor IX-deficient human plasmas, the thromboplastic activity seems to be due to tissue thromboplastin of the tumour cells themselves. Thromboplastic activity of the cancer cells seems to be very important in terms of the pathophysiology of the patients with malignancy, such as thrombosis, non-bacterial thrombotic endocarditis (Rohner et al, 1966) and disseminated intravascular coagulation syndrome (Peck & Reiquam, 1973). This activity is also considered to be closely related to fibrin deposition at the advancing border of tumours (Tanaka et al, 1977) and to the lodgement of circulating tumour cells in remote organs by tlhrombus formation (Kinjo, 1978 The cultured human cancer cells also showed varied fibrinolytic activity.…”

“…THROMBOPLASTIC and fibrinolytic activities of tumour cells themselves are considered to be important factors in the following events: first, thrombosis (Rohner et at., 1966) and disseminated intravascular coagulation syndrome (Peck & Reiquam, 1973) in cancer patients; second, local growth of the tumour at the primary site (Peterson, 1968); third, haematogenous metastases in the form of lodgement and extravasation of arrested tumour cells in remote organs (Tanaka et al, 1977).…”