Gallbladder cancer-associated thrombotic microangiopathy

Area of Science:

• Oncology
• Hematology

Background:

• Cancer-associated thrombotic microangiopathy (TMA) is a rare complication of malignancy.
• Typical features include large tumor burden, mucinous adenocarcinoma histology, and bone marrow infiltration, often from stomach, breast, or prostate cancers.
• Optimal therapy remains unclear, but prompt antineoplastic treatment is crucial.

Observation:

• This report details the first case of cancer-associated TMA secondary to gallbladder adenocarcinoma.
• The gallbladder cancer lacked typical features like mucinous histology and bone marrow involvement.
• The patient's presentation mimicked primary thrombotic thrombocytopenic purpura, leading to ineffective plasma exchange.

Findings:

• The patient's cancer-associated TMA was successfully treated with systemic chemotherapy.
• Chemotherapy led to a remarkable resolution of the TMA symptoms.
• This case highlights that cancer-associated TMA can occur in atypical presentations.

Implications:

• Early recognition and prompt chemotherapy are vital for managing cancer-associated TMA, even in unusual gallbladder cancer cases.
• Differentiating cancer-associated TMA from primary thrombotic thrombocytopenic purpura is challenging but critical for effective treatment.
• This case expands the understanding of cancer-associated TMA origins and treatment responses.