2022 Volume 33 Issue 3 Pages 283-287
The patient, a 39-year-old woman who was a cook by occupation, presented to the gynecology department with abnormal uterine bleeding and was diagnosed with endometrial cancer. At the time of admission, she was noted to have swelling of her right upper extremity and was referred to our department on suspicion of lymphedema due to subclavian lymph node metastasis. The venous phase of a contrast-enhanced CT showed a thrombus in the right subclavian vein, located between the clavicle and the first rib. We diagnosed this as a case of cancer associated venous thrombosis caused by endometrial cancer: the upper extremity deep vein thrombosis may also have been caused by chronic irritation as seen in Paget-Schroetter syndrome. Although anticoagulant or antithrombotic therapy was considered as the first choice of treatment, continued abnormal uterine bleeding precluded its use: therefore, total hysterectomy was performed first. The pain and swelling in the right upper extremity decreased before the surgery, even without anticoagulation. Postoperatively, anticoagulant therapy with apixaban was administered, and the swelling of the right upper extremity markedly improved. Presently, the patient is on maintenance therapy with apixaban.
