Occult recurrent breast cancer masquerading as thrombotic thrombocytopenic purpura

Wills‐Sanin, Beatriz; George, James N.; Boiocchi, Leonardo; Soff, Gerald A.; Mones, Jodi V.

doi:10.1002/ajh.26761

Cited by 2 publications

(2 citation statements)

References 6 publications

(13 reference statements)

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“…The most common malignancies associated with cancer-related MAHA and thrombocytopenia are adenocarcinomas, specifically gastric, breast, prostate, and lung [4,5]. Among breast cancer cases, lobular histology is frequently documented [6], but ductal and colloid types have also been reported [2,[7][8][9]. In our case, the bone marrow findings revealed tumor cells arranged in a single-file pattern, suggesting lobular histology, although confirmation awaited a possible biopsy of the primary tumor.…”

Section: Discussionmentioning

confidence: 52%

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Undiagnosed Metastatic Breast Carcinoma Presenting as Thrombotic Thrombocytopenic Purpura

Jackson,

Coke,

Oni

et al. 2023

Cureus

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Cancer-associated thrombotic microangiopathy has a documented relationship with metastatic disease. Other examples of thrombotic microangiopathy (TMA) include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). All these conditions can present with microangiopathic hemolytic anemia as well as thrombocytopenia. However, when these findings occur in association with cancer, they often carry a poor prognosis. Though associated with metastasis, microangiopathic hemolytic anemia, and thrombocytopenia have rarely been seen as the presenting signs of malignancy. We present the case of a 66-year-old female with no known history of cancer who exhibited an intriguing clinical presentation, including progressive dyspnea worsening with exertion, diarrhea, and dizziness. Laboratory investigations revealed Coombs-negative hemolytic anemia with schistocytes on blood smears and thrombocytopenia. The patient's condition raised concerns for TTP, prompting the initiation of plasmapheresis. However, despite treatment, the anemia and thrombocytopenia showed no improvement, leading to further investigations. Ultimately, a bone marrow biopsy revealed tumor cells arranged in nests and single files, leading to a diagnosis of metastatic carcinoma, consistent with breast primary. This was the patient’s first known sign of breast cancer. This case emphasizes the significance of considering metastatic cancer as a potential differential diagnosis in patients presenting with similar signs and symptoms.

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Section: Discussionmentioning

confidence: 52%

“…A biopsy of the bone marrow has proven most beneficial for diagnosis in most cases [ 3 ]. When the marrow is involved, clusters of malignant epithelial cells or single epithelial cells may be seen, particularly in breast cancer cases [ 7 , 8 ]. Similar findings were observed in the bone marrow biopsy in our case.…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed Metastatic Breast Carcinoma Presenting as Thrombotic Thrombocytopenic Purpura

Jackson,

Coke,

Oni

et al. 2023

Cureus

View full text Add to dashboard Cite

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Eculizumab/immune-globulin/tamoxifen

2023

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Occult recurrent breast cancer masquerading as thrombotic thrombocytopenic purpura

Abstract: GATA3 immunohistochemistry stain of the bone marrow biopsy required to diagnose recurrent metastatic breast cancer.

Cited by 2 publications

References 6 publications

Undiagnosed Metastatic Breast Carcinoma Presenting as Thrombotic Thrombocytopenic Purpura

Undiagnosed Metastatic Breast Carcinoma Presenting as Thrombotic Thrombocytopenic Purpura

Eculizumab/immune-globulin/tamoxifen

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