Korean J Lab Med.  2011 Jul;31(3):157-161. 10.3343/kjlm.2011.31.3.157.

Microangiopathic Hemolytic Anemia as the First Manifestation of Metastatic Signet Ring Cell Carcinoma of Unknown Origin: A Case Report and Review of Literature

• Shin SY
• Park H
• Chae SW
• Woo HY

• KMID: 1735847
• DOI: http://doi.org/10.3343/kjlm.2011.31.3.157

Abstract

Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.

Keyword

Bone marrow metastasis; Microangiopathic hemolytic anemia; Signet ring cell carcinoma

MeSH Terms

Aged, 80 and over
Bone Marrow Neoplasms/complications/*diagnosis/pathology
Carcinoma, Signet Ring Cell/complications/*diagnosis/pathology
Endoscopy, Gastrointestinal
Haptoglobins/metabolism
Humans
Immunohistochemistry
Male
Necrosis/etiology
Neoplasm Metastasis
Positron-Emission Tomography
Purpura, Thrombotic Thrombocytopenic/*diagnosis/etiology
Tomography, X-Ray Computed
Tumor Markers, Biological/analysis

Figure

• 

  Fig. 1 (A) Schistocytes, polychromasia, and a nucleated red blood cell (arrow) (peripheral blood smear, hematoxylin and eosin stain, ×1,000); (B) non-hematopoietic, large cell clusters are visible (bone marrow aspirate, Wright & Giemsa stain, ×400).

• 

  Fig. 2 (A) Trephine biopsy section reveals clusters of malignant cells with extensive necrosis (center, bone marrow [BM] biopsy section, hematoxylin and eosin stain [H&E], ×100). (B) Tumor cells show eccentrically located nuclei and abundant mucinous cytoplasm, consistent with signet ring cell carcinoma (BM biopsy section, H&E, ×400).

• 

  Fig. 3 Results of immunohistochemical analysis and Alcian blue staining. Tumor cells are positive for CK20 (A) and negative for CK7 stains (B). (C) Alcian blue stain reveals cytoplasmic mucin positivity in the tumor cells.

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