Internal jugular vein thrombosis presenting as paraneoplastic syndrome in benign cystic teratoma of ovary: a case report

Authors

  • Vidhya Ramalingam Department of Medical Oncology, Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai-8, Tamil Nadu, India
  • Lakshminarasimhan Srinivasan Department of Medical Oncology, Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai-8, Tamil Nadu, India
  • Madurai Padmanabhan Kanchana Department of Medical Oncology, Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai-8, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20164676

Keywords:

Benign cystic teratoma ovary, Internal jugular vein thrombosis, Paraneoplastic syndrome

Abstract

Internal jugular vein thrombosis is a rare vascular disease that can be overlooked or misdiagnosed and is generally seen in persons with intravenous drug abuse or in patients with prolonged central venous catheterization due to iatrogenic trauma. The most common germ cell tumour of the ovary is benign (mature) cystic teratoma, occurring in adolescents and young women. We are presenting a case of a 50-year-old premenopausal woman, diagnosed to have right internal jugular vein thrombosis extending into the right subclavian and axillary vein. Her laboratory investigations revealed no predisposing cause of thrombosis. Four months later she was evaluated for menorrhagia and imaging studies showed multiple uterine fibroids with left ovarian mass (ovarian teratoma) with moderate ascites and her tumour markers levels of CA125 was elevated. She underwent staging laparotomy, total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection with infracolic omentectomy. Pathologically, ovarian cyst showed mature thyroid tissue with islands of bone, muscle tissue and fatty tissue consistent with benign cystic teratoma. Postoperatively her tumour marker CA125 level returned to normal levels and there was no reaccumulation of fluid. As there were no predisposing factors for internal jugular vein thrombosis, it was concluded to be a paraneoplastic syndrome preceding the diagnosis of benign cystic teratoma. To the best of our knowledge this is the first case report in the literature with an association between internal jugular vein thrombosis and benign cystic teratoma with raised serum tumour marker CA 125.

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References

Boedeker CC, Ridder GJ, Weerda N. Etiology and therapy of the internal jugular vein thrombosis. Laryngo-Rhino-Otologie. 2004;83(11):743-9.

Park CH, Jung MH, Ji YI. Risk factors for malignant transformation of mature cystic teratoma. Obstet Gynecol Sci. 2015;58(6):475-80.

Atabekoglu C, Bozaci EA, Tezcan S. Elevated carbohydrate antigen 19-9 in a dermoid cyst. Int J Gynecol Obstet. 2005;91(3):262-3.

Madaan M, Puri M, Sharma R, Kaur H, Trivedi SS. Unusually high levels of Ca19-9 associated with mature cystic teratoma of the ovary. Case Rep Obstet Gynecol. 2014;:187910.

Dede M, Gungor S, Yenen MC, Alanbay I, Duru NK, Hasimi A. CA19-9 may have clinical significance in mature cystic teratomas of the ovary. Int J Gynecol Cancer. 2006;16(1):189-93.

Suh DS, Moon SH, Kim SC, Joo JK, Park WY, Kim KH. Significant simultaneous changes in serum CA19-9 and CA125 due to prolonged torsion of mature cystic teratoma of the ovary. World J Surg Oncol. 2014;12:353.

Chlumsky J, Havlin J. Spontaneous jugular vein thrombosis. Acta Cardio. 2009;64(5):689-91.

Pelosof LC, Gerber DE. Paraneoplastic syndromes: an approach to diagnosis and treatment. Mayo Clin Proc. 2010;85:838-54.

Madabhavi I, Patel A, Choudhary M, Anand A. Paraneoplastic Internal Jugular vein thrombosis leading to diagnosis of bilateral ovarian ependymoma. Case Reports in Obstetrics and Gynaecology. 2014, Article ID 324509. 4 pages.

Unsal EE, Karaca C, Ensari S. Spontaneous internal jugular vein thrombosis associated with distant malignancies. Eur Arch Otorhinolaryngol. 2003;260(1):39-41.

Chowdhury K, Bloom J, Black MJ, Al-Noury K. Spontaneous and nonspontaneous internal jugular vein thrombosis. Head Neck. 1990;12:168-73.

Edwards RL, Rickels FR. Thrombosis and cancer. Prog Hemost Thromb. 1996;35:374-82.

Geddings JE and Mackman N. Tumour-derived tissue factor – positive microparticles and venous thrombosis in cancer patients. Blood. 2013;122(11):1873-80.

Caine GJ, Stonelake PS. The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia. 2002; 4(6):465-73.

Ustunyurt E, Gungor T, Iskender C, Ustunyurt BO, Bilge U, Mollamahmutoglu L. Tumour markers in mature cystic teratomas of the ovary. Arch Gynecol Obstet. 2009;279(2):145-7.

Parithivel K, Jagannathan JP, Krajewski K. Ovarian squamous cell carcinoma arising from mature cystic teratoma. Cancer Imaging. 2011;11:67-9.

Kudva R, Ayachit GS, Ayachit A. Malignant melanoma arising in an ovarian mature cystic teratoma - a rare entity. J Clin Diagn Res. 2015;9(4):ED14-6.

Ulkumen BA, Goker A, Pala HG, Ordu S. Abnormal elevated Ca 19-9 in the dermoid cyst: a sign of the ovarian torsion? Case Rep Obstet Gynecol. 2013;20(13):860.

Asher V, Hammond R and Duncan TJ. Pelvic mass associated with raised Ca125 for benign condition: a case report. World J Surg Oncol. 2010;8:28.

Paavonen J, Miettinen A, Heinonen PK, Aaran RK, Teisala K, Aine R et al. Serum CA 125 in acute pelvic inflammatory disease. Br J Obstet Gynecol. 1989;96(5):574-9.

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Published

2016-12-20

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Case Reports