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Hematological Paraneoplastic Syndrome and Heparin-Induced Thrombocytopenia in Untreated Parotid Acinic Cell Carcinoma
Suthaharan Ragulan1, Tom Walker2, Prince Modayil1
1Department of Otolaryngology, St George's University Hospitals NHS Foundation Trust, England, UK.
Rationale:
Acinic cell carcinoma (ACC) is a rare and indolent malignancy commonly found in the parotid gland. This can give rise to paraneoplastic syndromes, which represent the clinical manifestations of indirect and remote events produced by tumour metabolites.
Patient Concerns:
A 38-year-old Afro-Caribbean female suffered an indolent parotid mass. She only presented to our tertiary center when it started to ulcerate and bleed.
Diagnosis:
She was diagnosed with advanced parotid ACC. She also went on to develop an hematological paraneoplastic syndrome resulting in venous thrombi. This was complicated by her developing heparin-induced thrombocytopenia (HIT).
Treatment:
A difficult multidisciplinary decision was made to proceed with surgery despite her extremely poor condition.
Outcomes:
After the surgery, the patient made a full recovery.
Take-Away Lessons:
ACC is a relatively uncommon and indolent malignancy that is usually found in the parotid gland. It can be associated with a hematological paraneoplastic syndrome and further complicated by iatrogenic HIT.
