Disseminated Intravascular Coagulation in a Patient with Metastatic Pancreatic Neuroendocrine Tumour: A Case Report and Review of the Literature
Affiliation(s)
1 Department of Clinical Oncology, Singleton Hospital, Swansea, UK. 2 Department of Radiology, Singleton Hospital, Swansea, UK.
1 Department of Clinical Oncology, Singleton Hospital, Swansea, UK. 2 Department of Radiology, Singleton Hospital, Swansea, UK.
ABSTRACT
A 67-year-old female patient presented with weight loss, diarrhoea and thrombocytopaenia of unknown aetiology. A computerised tomography (CT) scan demonstrated a mass in the head of the pancreas with liver metastases. A liver biopsy demonstrated a well-differentiated neuroendocrine carcinoma. She was commenced on a somatostatin analogue. Three months later she presented with spontaneous bleeding. Blood test demonstrated results consistent with disseminated intravascular coagulation (DIC). A restaging CT scan showed evidence of disease progression. The DIC was felt to be due to the underlying progressive malignancy. Having considered the potential risks associated with cytotoxic therapy in the context of a consumptive coagulopathy, the patient was commenced on weekly Carboplatin. The patient’s blood counts improved rapidly, and her bruising and bleeding resolved. Following a few weeks of stable blood results and clinical stability, her cytotoxic treatment was changed to a combination of Carboplatin and Etoposide, and to date she remains well on treatment.
A 67-year-old female patient presented with weight loss, diarrhoea and thrombocytopaenia of unknown aetiology. A computerised tomography (CT) scan demonstrated a mass in the head of the pancreas with liver metastases. A liver biopsy demonstrated a well-differentiated neuroendocrine carcinoma. She was commenced on a somatostatin analogue. Three months later she presented with spontaneous bleeding. Blood test demonstrated results consistent with disseminated intravascular coagulation (DIC). A restaging CT scan showed evidence of disease progression. The DIC was felt to be due to the underlying progressive malignancy. Having considered the potential risks associated with cytotoxic therapy in the context of a consumptive coagulopathy, the patient was commenced on weekly Carboplatin. The patient’s blood counts improved rapidly, and her bruising and bleeding resolved. Following a few weeks of stable blood results and clinical stability, her cytotoxic treatment was changed to a combination of Carboplatin and Etoposide, and to date she remains well on treatment.
KEYWORDS
Pancreatic Neuroendocrine Tumour, Disseminated Intravascular Coagulation, Consumptive Coagulopathy
Pancreatic Neuroendocrine Tumour, Disseminated Intravascular Coagulation, Consumptive Coagulopathy
Cite this paper
Davies, R. , Wells, T. and Gwynne, S. (2014) Disseminated Intravascular Coagulation in a Patient with Metastatic Pancreatic Neuroendocrine Tumour: A Case Report and Review of the Literature. Case Reports in Clinical Medicine, 3, 549-553. doi: 10.4236/crcm.2014.310119.
Davies, R. , Wells, T. and Gwynne, S. (2014) Disseminated Intravascular Coagulation in a Patient with Metastatic Pancreatic Neuroendocrine Tumour: A Case Report and Review of the Literature. Case Reports in Clinical Medicine, 3, 549-553. doi: 10.4236/crcm.2014.310119.
References
[1] Ito, K., Yanagisawa, S., Okada, D., et al. (2006) A Case of Giant Liver Metastases from Rectal Carcinoid Accompanied DIC. Japanese Journal of Gastroenterological Surgery, 39, 1440-1445.
http://dx.doi.org/10.5833/jjgs.39.1440 [2] Teh, R.W. and Tsoi, D.T. (2012) Acute Disseminated Intravascular Coagulation in Neuroendocrine Carcinoma. Case Reports in Oncology, 5, 524-529.
http://dx.doi.org/10.1159/000338401 [3] Turaga, K.K. and Kvols, L.K. (2011) Recent Progress in the Understanding, Diagnosis, and Treatment of Gastroenteropancre-Atic Neuroendocrine Tumours. CA—A Cancer Journal for Clinicians, 61, 113-132.
http://dx.doi.org/10.3322/caac.20097 [4] Oberg, K., Knigge, U., Kwekkeboom, D., et al. (2012) Neuroendocrine Gastro-Entero-Pancreatic Tumors: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Annals of Oncology, 23, 124-130. [5] Pape, U.F., Bohmig, M., Tiling, N., et al. (2004) Survival and Clinical Outcome of Patients with Neuroendocrine Tuours of the Gastroenteropancreatic Tract in a German Referral Centre. Annals of the New York Academy of Sciences, 1014, 222-233.
http://dx.doi.org/10.1196/annals.1294.025 [6] Valle, J.W., Eatock, M., Clueit, B., et al. (2014) A Systematic Review of Non-Surgical Treatments for Pancreatic Neuroendo-Crinetumours. Cancer Treatment Reviews, 40, 376-389.
http://dx.doi.org/10.1016/j.ctrv.2014.06.003 [7] Levi, M., Toh, C.H., Thachil, J., et al. (2009) Guidelines for the Diagnosis and Management of Disseminated Intravascular Coagulation. British Journal of Haematology, 145, 24-33.
http://dx.doi.org/10.1111/j.1365-2141.2009.07600.x
[1] Ito, K., Yanagisawa, S., Okada, D., et al. (2006) A Case of Giant Liver Metastases from Rectal Carcinoid Accompanied DIC. Japanese Journal of Gastroenterological Surgery, 39, 1440-1445.
http://dx.doi.org/10.5833/jjgs.39.1440 [2] Teh, R.W. and Tsoi, D.T. (2012) Acute Disseminated Intravascular Coagulation in Neuroendocrine Carcinoma. Case Reports in Oncology, 5, 524-529.
http://dx.doi.org/10.1159/000338401 [3] Turaga, K.K. and Kvols, L.K. (2011) Recent Progress in the Understanding, Diagnosis, and Treatment of Gastroenteropancre-Atic Neuroendocrine Tumours. CA—A Cancer Journal for Clinicians, 61, 113-132.
http://dx.doi.org/10.3322/caac.20097 [4] Oberg, K., Knigge, U., Kwekkeboom, D., et al. (2012) Neuroendocrine Gastro-Entero-Pancreatic Tumors: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Annals of Oncology, 23, 124-130. [5] Pape, U.F., Bohmig, M., Tiling, N., et al. (2004) Survival and Clinical Outcome of Patients with Neuroendocrine Tuours of the Gastroenteropancreatic Tract in a German Referral Centre. Annals of the New York Academy of Sciences, 1014, 222-233.
http://dx.doi.org/10.1196/annals.1294.025 [6] Valle, J.W., Eatock, M., Clueit, B., et al. (2014) A Systematic Review of Non-Surgical Treatments for Pancreatic Neuroendo-Crinetumours. Cancer Treatment Reviews, 40, 376-389.
http://dx.doi.org/10.1016/j.ctrv.2014.06.003 [7] Levi, M., Toh, C.H., Thachil, J., et al. (2009) Guidelines for the Diagnosis and Management of Disseminated Intravascular Coagulation. British Journal of Haematology, 145, 24-33.
http://dx.doi.org/10.1111/j.1365-2141.2009.07600.x