Chronic diffuse intravascular coagulation (DIC) in nonmetastatic ovarian cancer. Report of a case and review of the literature

A patient with a dramatic clinical picture of cerebral artery occlusion, peripheral artery occlusion, and pulmonary embolism was diagnosed as suffering from disseminated intravascular coagulation (DIC) according to the typical laboratory findings of hypofibrinogenemia, hypoprothrombinemia, relative thrombocytopenia, and reduction of other clotting factors. Increased fibrinogen split products (FSP) were found on several occasions later in the disease. Heparin was effective in controlling the syndrome which recurred when treatment was stopped. The cause of the syndrome was an ovarian tumor. The patient died of acute myocardial infarction. The postmortem examination confirmed the diagnosis of DIC, the primary disease being a mucinous cystadenocarcinoma of the right ovary, and revealed that the terminal myocardial infarction was also the result of DIC. The surprise was that the tumor was solitary and without metastases. The literature dealing with chronic DIC in cancer is reviewed, and its diagnosis, frequency, and association with metastases is assessed.