Deep vein thrombosis (DVT) in ovarian clear cell carcinoma with liver metastasis: a case report

Fahrani Imanina Putri Nurtyas , Astuti Giantini

Fahrani Imanina Putri Nurtyas
Clinical Pathology Residency Program, Faculty of Medicine, University of Indonesia, Cipto Mangukusumo National Central General Hospital, Jakarta.. Email:

Astuti Giantini
Clinical Pathology Department, Faculty of Medicine, University of Indonesia, Cipto Mangukusumo National Central General Hospital, Jakarta.
Online First: April 23, 2019 | Cite this Article
Nurtyas, F., Giantini, A. 2019. Deep vein thrombosis (DVT) in ovarian clear cell carcinoma with liver metastasis: a case report. Bali Medical Journal 8(2): 385-389. DOI:10.15562/bmj.v8i2.1472

Introduction: Deep vein thrombosis (DVT) is a common complication found in malignancy patients. If not handled properly, this condition can be fatal. As many as 1-8% of cases developed into pulmonary embolism and cause death. Malignancy associated thrombosis is second leading cause of death in patients with malignancy. Ovarian clear cell carcinoma has the highest risk of thrombosis compared to other carcinomas, 5-16% of patients with ovarian malignancy. This condition is aggravated by liver metastasis.

Case: 36-year-old woman with left ovarian clear cell carcinoma stage IVB, get a series of Carboplatin and Paclitaxel chemotherapy, complained severe pain in the left leg that progressively increase with edema and erythema from the thigh to the calf. Patient was diagnosed as suspected DVT with Wells’ scores 5 that supported by an increase in D-dimer and bilateral lower extremity venous doppler ultrasound showing DVT in the communal femoral, superficial femoral, and popliteal veins of the left leg. Abdominal CT scan result show liver metastasis with massive ascites. The patient was treated with 2 x 40 mg furosemide, 5000 units of heparin bolus followed by 20000 units of heparin drip / 24 hours and 1 x 2 mg bridging Simarc. PT and APTT result show prolongation.

Conclusion: We reported a case of DVT in left ovarian clear cell carcinoma stage IVB with liver metastasis. This case emphasizes coagulopathy manifestation in malignancy that can be caused by cancer management and the use of anticoagulants that are aggravated by liver metastasis.


Elyamany G, Alzahrani AM, Bukhary E. Cancer-associated thrombosis: an overview. Clin Med Insights Oncol. 2014; 8:129-37.

Metcalf RL, Fry DJ, Swindell R, McGurk A, Clamp AR, Jayson GC, et al. Thrombosis in ovarian cancer: a case-control study. Br J Cancer. 2014; 110(5):1118-24.

Bakhru A. Effect of ovarian tumor characteristics on venous thromboembolic risk. J Gynec Oncol. 2013; 24(1):52-58.

Ye S, Yang J, Cao D, Bai H, Huang H, Wu M, et al. Characteristic and prognostic implication of venous thromboembolism in ovarian clear cell carcinoma: a 12-year retrospective study. PloS One. 2015; 10(3):e0121818

Matsuo K, Hasegawa K, Yoshino K, Murakami R, Hisamatsu T, Stone RL, et al. Venous thromboembolism, interleukin-6 and survival outcomes in patients with advanced ovarian clear cell carcinoma. Eur J Cancer. 2015; 51(14):1978-88.

Podduturi V, Guileyardo JM. Clear cell carcinoma of the ovary associated with increased risk of venous thrombosis. Proc Bayl Univ Med Cent. 2014; 27(4):338–40.

Ebina Y, Uchiyama M, Imafuku H, Suzuki K, Miyahara Y, Yamada H. Risk factors for deep venous thrombosis in women with ovarian cancer. Medicine (Baltimore). 2018; 97(23):e11009.

Rahajuningsih DS. Hemostasis dan Trombosis. 6th ed. Jakarta: Badan Penerbit Fakultas Kedokteran Universitas Indonesia; 2018; 35-75.

Piazza G. Venous thromboembolism and cancer. Circulation. 2013; 128:2614-8.

Gabali A, Kirby B. Disorders of secondary hemostasis. In: McKenzie SB, Williams JL, editors. Clinical Laboratory Hematology. 3rd ed. New York: Pearson; 2016. p. 738-43.

Brown A. Preventing venous thromboembolism in hospitalized patients with cancer. Am J Health Syst Pharm. 2012; 69(6):469-81.

Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein thrombosis. BMJ. 2005;326:1180-4.

Wilbur J, Shian B. Diagnosis of deep venous thrombosis and pulmonary embolism. Am Fam Physician. 2012;86(10):913-9.

No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0