A case of mouth floor cancer accompanied with essential thrombocythemia

Abstract

Essential thrombocythemia （ET） is a myeloproliferative neoplasm characterized by an increase in platelets due to abnormalities in bone marrow hematopoietic stem cells. Control of platelet count and antithrombotic therapy are important in the perioperative period because ET could cause bleeding and thrombosis. We report a case of performing surgery on mouth floor cancer accompanied by ET. A 70-year-old man was referred to our hospital in September 2016 for the indication of a tumor in the right mouth floor. A biopsy showed a pathological diagnosis of squamous cell carcinoma. The clinical diagnosis from imaging examinations was mouth floor cancer T2N1M0. He had been treated with hydroxycarbamide （HU） and dipyridamole since the diagnosis of ET in 2004. The platelet count was 94.1×10⁴/μl at the preoperative blood test, so we increased the dose of HU before surgery. As a result, the count decreased to 50.4×10⁴/μl on the day of the surgery. Also, we stopped dipyridamole before surgery. He underwent tracheostomy, functional neck dissection, partial resection of the mouth floor and tongue, and reconstruction with a radial forearm free flap in November 2016. When the platelet count increased postoperatively, HU was resumed. Furthermore, daltepalin sodium was started intravenously at the time when the amount of bleeding decreased. He had no perioperative complications due to the control of platelet count or antithrombotic therapy.