A case of embolic stroke associated with undifferentiated pleomorphic sarcoma

Abstract

The patient is a 73-year-old man. The patient was brought to the emergency room with a chief complaint of dizziness. A head MRI showed multiple infarcts in the cerebral and cerebellar hemispheres. No obvious embolic source could be identified, but the patient had a history of undifferentiated pleomorphic sarcoma of the right humerus and multiple metastases were suspected. So, this case was diagnosed as cerebral infarction due to cancer-associated thrombosis (CAT). After starting subcutaneous injections of heparin calcium, there was no recurrence. However, 2 weeks after switching from heparin calcium to a direct oral anticoagulant, embolic stroke recurred. It is said that adenocarcinoma is the most common cancer causing CAT because mucins secreted by adenocarcinoma cells form microplatelet thrombi. However, it was reported that malignant tumors other than adenocarcinoma also cause CAT. In particular, it is known that the risk of thrombosis increases in cases with distant metastases. When a patient with malignant tumor with metastasis has embolic stroke, it is necessary to consider the possibility of cancer-associated thrombosis, even if it is not adenocarcinoma.