Disseminated Intravascular Coagulation in a Patient with Metastatic Pancreatic Neuroendocrine Tumour: A Case Report and Review of the Literature

摘要

A 67-year-old female patient presented with weight loss, diarrhoea and thrombocytopaenia of unknown aetiology. A computerised tomography (CT) scan demonstrated a mass in the head of the pancreas with liver metastases. A liver biopsy demonstrated a well-differentiated neuroendocrine carcinoma. She was commenced on a somatostatin analogue. Three months later she presented with spontaneous bleeding. Blood test demonstrated results consistent with disseminated intravascular coagulation (DIC). A restaging CT scan showed evidence of disease progression. The DIC was felt to be due to the underlying progressive malignancy. Having considered the potential risks associated with cytotoxic therapy in the context of a consumptive coagulopathy, the patient was commenced on weekly Carboplatin. The patient’s blood counts improved rapidly, and her bruising and bleeding resolved. Following a few weeks of stable blood results and clinical stability, her cytotoxic treatment was changed to a combination of Carboplatin and Etoposide, and to date she remains well on treatment.