Catastrophic antiphospholipid syndrome associated with malignancies (case report and review of the literature) Lupus. anticardiolipin antibodies. Following a high alkaline phosphatase, diffuse bone marrow involvement was found by whole body bone scan. Looking to find primary tumor, a large infilterable lesion in gastric was seen by endoscopic images, and biopsy histopathology showed a signet ring cell adenocarcinoma. The patient refused chemotherapy and died 6 months after diagnosis. Conclusions: APS is usually associated with gastric signet ring cell adenocarcinoma. strong class=”kwd-title” MeSH Keywords: Antibodies, Anticardiolipin; Antiphospholipid Syndrome; Stomach Neoplasms Background Antiphospholipid syndrome (APS) is usually a rare autoimmune disease characterized by arterial, venous, and small-vessel thrombosis, pregnancy-related morbidity and the presence of antiphospholipid antibodies such as anticardiolipin antibody, lupus anticoagulant, and/or anti-beta2-glycoprotein I . There are several reports around the association between APS and malignancies . The presence of APS in patients with solid tumor is usually linked with thrombotic complications. The review of cases with APS and tumor revealed that this renal cancer, lung carcinoma and breast tumors were the most common tumors linked with APS. Only 1 1 case of stomach malignancy with APS was found in the literature . Here, we report a case of APS following gastric signet ring cell adenocarcinoma. Case Report A 53-year-old female was referred to our hospital with pain and pitting edema of left lower extremity that had begun 6 months prior to hospitalization. Deep vein thrombosis (DVT) in the popliteal vein diagnosed by color Doppler ultrasonography. The patient treated with 1100 U/hour SRT 1720 Hydrochloride heparin and discharged from the hospital on warfarin 5 mg daily with international normalized ratio (INR) 2.2 after pain relief. The patient returned 1 month later, and a cerebral computed tomography (CT) scan revealed a subdural hematoma in hemisphere. This hematoma caused mass effect to lateral ventricle and subfalcine herniation. Following subdural hematoma, anticoagulant therapy was stopped, and the patient underwent craniotomy. One month after the craniotomy, the patient returned with pain and swelling of right leg. She had anorexia and weight loss of 4 kg over the last 4 months. On examination, body temperature, blood pressure, pulse rate, and respiratory rate were 36.5C, 120/80 mm Hg, 78 beats, and 14 breaths per minute, respectively. Heart and lung auscultation were normal. The patient had moderate epigastric tenderness without rebound. Difference between distal and proximal of right and left lower extremity was about 4 cm. Color Doppler ultrasonography showed DVT in the popliteal vein. Inferior vena cava (IVC) filter placed in the patient because of the history of intra-cranial bleeding. Follow-up laboratory tests showed a thrombocytopenia and a prolonged partial thromboplastin time (PTT) despite stopping the anticoagulants. Hemoglobin concentration was reduced to 8.6 g/dL (normal: 11.3C14.5 g/dL) and platelet count was 47 000/L that was below normal range (150 000C450 000/L). The C-reactive protein was 51 mg/dL (normal 0.2 mg/dL) and erythrocyte sedimentation rate (ESR) was 114 mm/hour (normal 15 mm/hour). C3 (90C180 mg/dL), C4 (13C75 mg/dL), and total complement activity (CH50) were in normal level. APS was suspected so serology was sent and it showed a high titer (45 U/mL) of IgM anticardiolipin antibodies (normal 18 U/mL), IgG anticardiolipin antibodies equal to 55 U/mL (normal Rabbit Polyclonal to CLK1 18 U/mL), and lupus anticoagulant equal to 48 U/mL (normal 35 U/mL). Anti-double stranded DNA (anti-dsDNA), and antinuclear antibody (ANA) were unfavorable. Alkaline phosphatase (ALP) was increased to 3783 U/L (normal: 20C70 U/L), and the level of gamma SRT 1720 Hydrochloride glutamyl transferase (GGT) was 35 U/L (6C37 U/L). Therefore, the whole-body bone scan was performed to detect infiltrative bone disease in the patient SRT 1720 Hydrochloride suspected to APS. The scan showed nonhomogeneous radiotracer uptake in the skull, spine, pelvic, and faint foci of increased radiotracer uptake in the proximal portion of both femurs. This result suggested bone metastasis. Upper endoscopy was performed as a part of work up for the primary tumor, which revealed a large infilterable lesion (43 cm) in the stomach (Physique 1). A biopsy was taken which showed adenocarcinoma with signet ring cell component. Histologic analysis of the gastric biopsy shows atypical cells with hyperchromatic nuclei and eosinophilic cytoplasm are arranged as glandular structures. (Physique 2). Other organs were checked for metastasis. Triphasic.