Optimal cytoreductive surgery for underlying ovarian cancer associated with deep venous thrombosis without placement of inferior vena cava filter: A case report and literature review

Shen,Hongwei; Shang,Jianhong; Niu,Gang; Liu,Jun; You,Zeshan; He,Shanyang

doi:10.3892/ol.2015.3497

Optimal cytoreductive surgery for underlying ovarian cancer associated with deep venous thrombosis without placement of inferior vena cava filter: A case report and literature review

Authors:
- Hongwei Shen
- Jianhong Shang
- Gang Niu
- Jun Liu
- Zeshan You
- Shanyang He
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Affiliations: Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat‑Sen University, Guangzhou, Guangdong 510080, P.R. China
Published online on: July 15, 2015 https://doi.org/10.3892/ol.2015.3497
Pages: 2579-2583

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Abstract

Ovarian cancer associated with deep venous thrombosis (DVT) is an uncommon, potentially life-threatening condition. The primary therapeutic strategy for the treatment of this condition is up-front primary cytoreductive surgery, with placement of an inferior vena cava (IVC) filter prior to surgery to prevent fatal pulmonary embolism. The present study describes the case of a 49-year-old female, who presented with DVT unresponsive to anticoagulant therapy in the lower extremities prior to the diagnosis of ovarian cancer. During the search for the underlying malignancy, transvaginal sonography (TVS) revealed a cystic solid mass in the pelvic cavity. Subsequently, the patient underwent up-front primary cytoreductive surgery without placement of a preoperative IVC filter, followed by six cycles of chemotherapy. The patient was diagnosed with ovarian clear cell adenocarcinoma stage IIIC, complicated by DVT, and had survived >3 years without relapse at the time of completion of the present study. The successful outcome of the present case demonstrated that occult primary cancer should be suspected in patients with DVT unresponsive to anticoagulant therapy. The present study also indicated that up-front primary cytoreductive surgery without placement of an IVC filter represents an effective potential strategy for the treatment of advanced ovarian cancer associated with DVT, as the thrombus strongly adheres to the vessel wall following organization.

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1	Jayson GC, Kohn EC, Kitchener HC and Ledermann JA: Ovarian cancer. Lancet. 384:1376–1388. 2014. View Article : Google Scholar : PubMed/NCBI
2	MorganRJ Jr, Alvarez RD, Armstrong DK, Burger RA, Castells M, Chen LM, Copeland L, Crispens MA, Gershenson D, Gray H, et al: National Comprehensive Cancer Network: Ovarian cancer, version 3.2012. J Natl Compr Canc Netw. 10:1339–1349. 2012.PubMed/NCBI
3	Tateo S, Mereu L, Salamano S, Klersy C, Barone M, Spyropoulos AC and Piovella F: Ovarian cancer and venous thromboembolic risk. Gynecol Oncol. 99:119–125. 2005. View Article : Google Scholar : PubMed/NCBI
4	AbuSaadeh F, Norris L, O'Toole S and Gleeson N: Venous thromboembolism in ovarian cancer: Incidence, risk factors and impact on survival. Eur J Obstet Gynecol Reprod Biol. 170:214–218. 2013. View Article : Google Scholar : PubMed/NCBI
5	Dewdney SB, Benn T, Rimel BJ, Gao F, Saad N, Vedantham S, Mutch DG and Zighelboim I: Inferior vena cava filter placement in the gynecologic oncology patient: A 15-year institutional experience. Gynecol Oncol. 121:344–346. 2011. View Article : Google Scholar : PubMed/NCBI
6	Sing RF and Fischer PE: Inferior vena cava filters: Indications and management. Curr Opin Cardiol. 28:625–631. 2013. View Article : Google Scholar : PubMed/NCBI
7	Duffett LD, Gándara E, Cheung A, Bose G, Forster AJ and Wells PS: Outcomes of patients requiring insertion of an inferior vena cava filter: A retrospective observational study. Blood Coagul Fibrinolysis. 25:266–271. 2014. View Article : Google Scholar : PubMed/NCBI
8	Sella DM and Oldenburg WA: Complications of inferior vena cava filters. Semin Vasc Surg. 26:23–28. 2013. View Article : Google Scholar : PubMed/NCBI
9	Lee JK, So YH, Choi YH, Park SS, Heo EY, Kim DK and Chung HS: Clinical course and predictive factors for complication of inferior vena cava filters. Thromb Res. 133:538–543. 2014. View Article : Google Scholar : PubMed/NCBI
10	Matsuo K, Carter CM, Ahn EH, Prather CP, Eno ML, Im DD and Rosenshein NB: Inferior vena cava filter placement and risk of hematogenous distant metastasis in ovarian cancer. Am J Clin Oncol. 36:362–367. 2013. View Article : Google Scholar : PubMed/NCBI
11	Noble S and Pasi J: Epidemiology and pathophysiology of cancer-associated thrombosis. Br J Cancer. 102 (Suppl 1):S2–S9. 2010. View Article : Google Scholar : PubMed/NCBI
12	Blom JW, Doggen CJM, Osanto S and Rosendaal FR: Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA. 293:715–722. 2005. View Article : Google Scholar : PubMed/NCBI
13	Arora M and Wun T: Adverse impact of venous thromboembolism on patients with cancer. Semin Thromb Hemost. 40:313–318. 2014. View Article : Google Scholar : PubMed/NCBI
14	Bierry G, Holl N, Kellner F, Riehm S, Roedlich MN, Greget M and Veillon F: Venous thromboembolism and occult malignancy: Simultaneous detection during pulmonary CT angiography with CT venography. AJR Am J Roentgenol. 191:885–9. 2008. View Article : Google Scholar : PubMed/NCBI
15	Murchison JT, Wylie L and Stockton DL: Excess risk of cancer in patients with primary venous thromboembolism: A national, population-based cohort study. Br J Cancer. 91:92–95. 2004. View Article : Google Scholar : PubMed/NCBI
16	Metcalf RL, Fry DJ, Swindell R, McGurk A, Clamp AR, Jayson GC and Hasan J: Thrombosis in ovarian cancer: A case control study. Br J Cancer. 110:1118–1124. 2014. View Article : Google Scholar : PubMed/NCBI
17	Gunderson CC, Thomas ED, Slaughter KN, Farrell R, Ding K, Farris RE, Lauer JK, Perry LJ, McMeekin DS and Moore KN: The survival detriment of venous thromboembolism with epithelial ovarian cancer. Gynecol Oncol. 134:73–77. 2014. View Article : Google Scholar : PubMed/NCBI
18	Matsuura Y, Robertson G, Marsden DE, Kim SN, Gebski V and Hacker NF: Thromboembolic complications in patients with clear cell carcinoma of the ovary. Gynecol Oncol. 104:406–410. 2007. View Article : Google Scholar : PubMed/NCBI
19	AbuSaadeh F, Norris L, O'Toole S, Mohamed BM, Langhe R, O'Leary J and Gleeson N: Tumour expression of tissue factor and tissue factor pathway inhibitor in ovarian cancer - relationship with venous thrombosis risk. Thromb Res. 132:627–634. 2013. View Article : Google Scholar : PubMed/NCBI
20	Hurtt CC, Cliby WA, Weaver AL, McGree M, Martin J and Bakkum-Gamez JN: Management of epithelial ovarian cancer in the setting of concomitant venous thromboembolism. Obstet Gynecol. 123 (Suppl 1):183S–184S. 2014. View Article : Google Scholar
21	Ha JE, Lee YS, Lee HN and Park EK: Diagnostic laparoscopy of patient with deep vein thrombosis before diagnosis of ovarian cancer: A case report. Cancer Res Treat. 42:48–52. 2010. View Article : Google Scholar : PubMed/NCBI
22	Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, Verheijen RH, van der Burg ME, Lacave AJ, Panici PB, et al: European Organization for Research and Treatment of Cancer-Gynaecological Cancer Group; NCIC Clinical Trials Group: Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 363:943–953. 2010. View Article : Google Scholar : PubMed/NCBI
23	vanMeurs HS, Tajik P, Hof MH, Vergote I, Kenter GG, Mol BW, Buist MR and Bossuyt PM: Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer. 49:3191–3201. 2013. View Article : Google Scholar : PubMed/NCBI
24	AlHakim R, Kee ST, Olinger K, Lee EW, Moriarty JM, McWilliams JP and AI-Hakim R: Inferior vena cava filter retrieval: Effectiveness and complications of routine and advanced techniques. J Vasc Interv Radiol. 25:933–939. 2014. View Article : Google Scholar : PubMed/NCBI
25	Köhn H, König B and Mostbeck A: Incidence and clinical feature of pulmonary embolism in patients with deep vein thrombosis: A prospective study. Eur J Nucl Med. 13 (Suppl):S11–S15. 1987. View Article : Google Scholar : PubMed/NCBI