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Central European Journal of Medicine

, Volume 5, Issue 1, pp 140–143 | Cite as

A metastatic gastric cancer mimicking a chronic myeloproliferative disorder

  • Esin Beyan
  • Cengiz Beyan
Case Report
  • 25 Downloads

Abstract

It is known that coexistence of extreme thrombocytosis and thrombosis is observed frequently in chronic myeloproliferative disorders. In this paper, we report a patient who was prediagnosed with chronic myeloproliferative disorder; however, later on the diagnosis was confirmed as metastatic gastric cancer. The patient was a 75-year old female who was admitted with pain, swelling and erythema on her right arm. White blood cell count was 20 ×109/l, hemoglobin 5.2 g/dl and platelet count 1 088 ×109/l. Doppler ultrasonography revealed acute thrombotic process in right brachial vein. Since brachial vein thrombosis, thrombocytosis and anemia were seen together, the presumed diagnosis for this patient was chronic myeloproliferative disorder, and therapy with hydroxyurea, allopurinol and enoxaparin was started. One day after the heparin treatment, hematemesis and melena occurred. Eusophagogastroduodenal endoscopy showed an ulcerated and hemorrhagic polipoid lesion extending towards the cavity in the cardia region. Hydroxyurea treatment was stopped since the myeloproliferative disorder was excluded. Abdominal ultrasonography and tomography proved multiple metastatic lesions in the liver. Gastric and liver biopsies revealed “well differentiated adenocarcinoma” and 5-fluorouracil chemotherapy plus folinic acid was planned. As a result, in cases with thrombocytosis and thrombosis, metastatic cancers should be kept in mind besides chronic myeloproliferative disorders.

Keywords

Myeloproliferative disorders Stomach neoplasms Thrombocytosis Thrombosis Venous thrombosis 

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References

  1. [1]
    Dame C., Sutor A.H., Primary and secondary thrombocytosis in childhood, Br. J. Haematol., 2005, 129, 165–77CrossRefPubMedGoogle Scholar
  2. [2]
    Taksin A.L., Couedic J.P., Dusanter-Fourt I., Masse A., Giraudier S., Katz A., Wendling F., et al., Autonomous megakaryocyte growth in essential thrombocythemia and idiopathic myelofibrosis is not related to a c-mpl mutation or to an autocrine stimulation by Mpl-L, Blood, 1999, 93, 125–39PubMedGoogle Scholar
  3. [3]
    Schafer A.I., Thrombocytosis, N. Engl. J. Med., 2004, 350, 1211–9CrossRefPubMedGoogle Scholar
  4. [4]
    Coon W.W., Penner J., Clagett P., Eos N., Deep venous thrombosis and postsplenectomy thrombocytosis, Arch. Surg., 1978, 113, 429–31PubMedGoogle Scholar
  5. [5]
    De Stefano V., Teofili L., Leone G., Michiels J.J., Spontaneous erythroid colony formation as the clue to an underlying myeloproliferative disorder in patients with Budd-Chiari syndrome or portal vein thrombosis, Semin. Thromb. Hemost., 1997, 23, 411–8CrossRefPubMedGoogle Scholar
  6. [6]
    Lengfelder E., Hochhaus A., Kronawitter U., Höche D., Queisser W., Jahn-Eder M., et al., Should a platelet limit of 600 x 109/L be used as a diagnostic criterion in essential thrombocythaemia? An analysis of the natural course including early stages, Br. J. Haematol., 1998, 100, 15–23CrossRefPubMedGoogle Scholar
  7. [7]
    Regev A., Stark P., Blickstein D., Lahav M., Thrombotic complications in essential thrombocythemia with relatively low platelet counts, Am. J. Hematol., 1997, 56, 168–72CrossRefPubMedGoogle Scholar
  8. [8]
    Goldenberg N., Kahn S.R., Solymoss S., Markers of coagulation and angiogenesis in cancer-associated venous thromboembolism, J. Clin. Oncol., 2003, 21, 4194–9CrossRefGoogle Scholar
  9. [9]
    Sack G.H.Jr., Levin J., Bell W.R., Trousseau's syndrome and other manifestations of chronic disseminated coagulopathy in patients with neoplasms: Clinical, pathophysiologic, and therapeutic features, Medicine (Baltimore), 1977, 56, 1–37Google Scholar
  10. [10]
    Donati M.B., Cancer and thrombosis: From phlegmasia alba dolens to transgenic mice, Thromb. Haemost., 1995, 74, 278–81PubMedGoogle Scholar
  11. [11]
    Griesshammer M., Bangerter M., Sauer T., Wennauer R., Bergmann L., Heimpel H., Aetiology and clinical significance of thrombocytosis: analysis of 732 patients with an elevated platelet count, J. Intern. Med., 1999, 245, 295–300CrossRefPubMedGoogle Scholar
  12. [12]
    Buss D.H., Cashell A.W., O'Connor M.L., Richards F.2nd, Case L.D., Occurrence, etiology, and clinical significance of extreme thrombocytosis: a study of 280 cases, Am. J. Med., 1994, 96, 247–53CrossRefPubMedGoogle Scholar
  13. [13]
    Arslan C., Coskun H.S., Thrombocytosis in solid tumors: review of the literature. Turk. J. Haematol., 2005, 22, 59–64Google Scholar
  14. [14]
    Ikeda M., Furukawa H., Imamura H., Shimizu J., Ishida H., Masutani S., et al., Poor prognosis associated with thrombocytosis in patients with gastric cancer, Ann. Surg. Oncol., 2002, 9, 287–91CrossRefPubMedGoogle Scholar

Copyright information

© © Versita Warsaw and Springer-Verlag Berlin Heidelberg 2008

Authors and Affiliations

  1. 1.Department of Internal MedicineAnkara Numune Education and Research HospitalAnkaraTurkey
  2. 2.Department of HematologyGulhane Military Medical AcademyAnkaraTurkey

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