Autopsy and Case Reports
Autopsy and Case Reports
Article / Autopsy Case Report

Pulmonary thromboembolism secondary to pelvic thrombosis related to giant ovarian tumor

Alberto Amadasi; Salvatore Andreola; Marta Bianchi; Michele Boracchi; Guendalina Gentile; Francesca Maciocco; Matteo Marchesi; Riccardo Zoja

Downloads: 1
Views: 299


Pulmonary thromboembolism (PTE) is one of the major complications in oncologic patients. The incidence of PTE in these cases is 4 to 7 times higher than in non-oncologic patients. Ovarian tumors, specifically those of large sizes, may impair the blood flow through the pelvic veins as tumor pressure over the pelvic vessels increases the incidence of thrombosis. The authors report the case of the unexpected death of a 74-year-old female due to massive pulmonary thromboembolism, associated with an ovarian tumor almost of 15 kg of weight that filled the abdominal and pelvic cavities. The compressive effect on the walls of the pudendal and periuterine veins somehow facilitated the local thrombosis. According to the histological characterization on post-mortem samples, the mass was identified as an “atypical proliferative (borderline) mucinous tumor.” The case emphasizes the important association between pulmonary thromboembolism and ovarian tumors


Autopsy, Sudden Death, Ovarian Neoplasms, Pulmonary Thromboembolism


Svendsen E, Karwinski B. Prevalence of pulmonary embolism at necropsy in patients with cancer. J Clin Pathol. 1989;42(8):805-9. 10.1136/jcp.42.8.805.2475526

Satoh T, Oki A, Uno K, et al. High incidence of silent venous thromboembolism before treatment in ovarian cancer. Br J Cancer. 2007;97(8):1053-7. 10.1038/sj.bjc.6603989.17895896

Abu Saadeh F, Norris L, O’Toole S, et al. Tumour expression of tissue factor and tissue factor pathway inhibitor in ovarian cancer- relationship with venous thrombosis risk. Thromb Res. 2013;132(5):627-34. 10.1016/j.thromres.2013.09.016.24094893

Zhang Y, Yang JX, Wu M, Shen K. Clinicopathological conference: an advanced ovarian carcinoma patient suddenly died of pulmonary embolism. Zhongguo Yi. Xue Ke Yuan Xue Bao. 2003;25:471-5.

Shiota M, Kotani Y, Umemoto M, et al. Risk factors for deep-vein thrombosis and pulmonary thromboembolism in benign ovarian tumor. Tohoku J Exp Med. 2011;225(1):1-3. 10.1620/tjem.225.1.21817850

Rodriguez AO, Wun T, Chew H, Zhou H, Harvey D, White RH. Venous thromboembolism in ovarian cancer. Gynecol Oncol. 2007;105(3):784-90. 10.1016/j.ygyno.2007.02.024.17408726

Pineo GF, Brain HC, Gallus AS, Hirsh J, Hatton MW, Regoeczi E. Tumors, mucus production, and hypercoagulability. Am NY Acad Sci. 1974;230(1):262-70. 10.1111/j.1749-6632.1974.tb14458.x.4522873

Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy: risk analysis using medicare claims data. Medicine. 1999;78(5):285-91. 10.1097/00005792-199909000-00001.10499070

Boger-Megiddo I, Weiss NS. Histologic subtypes and laterality of primary epithelial ovarian tumors. Gynecol Oncol. 2005;97(1):80-3. 10.1016/j.ygyno.2004.11.054.15790441

Kurman RJ, Carcangiu ML, Herrington CS, et al. WHO classification of tumours of female reproductive organs. 4th ed. Lyon: WHO Press; 2014.

Ayhan A, Guvendag Guven ES, Guven S, Kucukali T. Recurrence and prognostic factors in borderline ovarian tumors. Gynecol Oncol. 2005;98(3):439-45. 10.1016/j.ygyno.2005.05.033.16009407

Jetley S, Khetrapal S, Ahmad A, Jairajpuri ZS. Atypical proliferative endometrioid tumor of ovary: report of a rare case. J Postgrad Med. 2016;62(2):129-32. 10.4103/0022-3859.168092.26497398

Janssen W. Forensic histopathology. Berlin: Springer; 1977.

Trousseau A. Clinique médicale de l’Hôtel-Dieu de Paris. Paris: JB Bailliere et Fils; 1865.

Gunderson CC, Thomas ED, Slaughter KN, et al. The survival detriment of venous thromboembolism with epithelial ovarian cancer. Gynecol Oncol. 2014;134(1):73-7. 10.1016/j.ygyno.2014.04.046.24793732

Heath OM, van Beekhuizen HJ, Nama V, et al. Venous thromboembolism at time of diagnosis of ovarian cancer: Survival differs in symptomatic and asymptomatic cases. Thromb Res. 2016;137:30-5. 10.1016/j.thromres.2015.11.030.26653367

Ikushima S, Ono R, Fukuda K, Sakayori M, Awano N, Kondo K. Trousseau’s syndrome: cancer-associated thrombosis. Jpn J Clin Oncol. 2016;46(3):204-8. 10.1093/jjco/hyv165.26546690

Lee AY, Levine MN, Butler G, et al. Incidence, risk factors, and outcomes of catheter-related thrombosis in adult patients with cancer. J Clin Oncol. 2006;24(9):1404-8. 10.1200/JCO.2005.03.5600.16549834

Caine GJ, Stonelake PS, Lip GY, Kehoe ST. The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia. 2002;4(6):465-73. 10.1038/sj.neo.7900263.12407439

Dvorak HF. Thrombosis and cancer. Hum Pathol. 1987;18(3):275-84. 10.1016/S0046-8177(87)80010-2.3546076

Rickles FR, Edwards RL. Activation of blood coagulation in cancer: Trousseau’s syndrome revisited. Blood. 1983;62(1):14-31.6407544

Belt RJ, Leite C, Haas CD, Stephens RL. Incidence of hemorrhagic complications in patients with cancer. JAMA. 1978;239(24):2571-4. 10.1001/jama.239.24.2571.660790

Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer. 2007;110(10):2339-46. 10.1002/cncr.23062.17918266

Bakhru A. Effect of ovarian tumor characteristics on venous thromboembolic risk. J Gynecol Oncol. 2013;24(1):52-8. 10.3802/jgo.2013.

Poller L. Oral contraceptives, blood clotting and thrombosis. Br Med Bull. 1978;34(2):151-6. 10.1093/oxfordjournals.bmb.a071485.350338

Uno K, Homma S, Satoh T, et al. Tissue factor expression as a possible determinant of thromboembolism in ovarian cancer. Br J Cancer. 2007;96(2):290-5. 10.1038/sj.bjc.6603552.17211468

Molnar S, Guglielmone H, Lavarda M, Rizzi ML, Jarchum G. Procoagulant factors in patients with cancer. Hematology. 2007;12(6):555-9. 10.1080/10245330701521416.17852460

De Cicco M. The prothrombotic state in cancer: pathogenic mechanisms. Crit Rev Oncol Hematol. 2004;50(3):187-96. 10.1016/j.critrevonc.2003.10.003.15182825

Kurman RJ. Blaustein’s Pathology of the female genital tract. 5th ed. New York: Springer; 2001. p. 791-904.

Srettabunjong S. Systemic thromboembolism after deep vein thrombosis caused by uterine myomas. Am J Forensic Med Pathol. 2013;34(3):207-9. 10.1097/PAF.0b013e318298a456.23835533

Srettabunjong S, Chuangsuwanich T. Inferior vena cava tumor thrombosis secondary to metastatic uterine cancer: a rare cause of sudden unexpected death. J Forensic Sci. 2016;61(2):555-8. 10.1111/1556-4029.13032.27404631




Publication date:

5c3cdb720e8825b20acd6227 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections