Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19

The COVID-19 pandemic brought into prominence several emergent medical and surgical entities, but, also, it served as trigger and contributor for numerous apparently unrelated ailments such as arterial and venous thromboembolic complications. Additional risk factors for these thrombotic traits may b...

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Main Authors: Mihai-Lucian Ciobica, Bianca-Andreea Sandulescu, Mihai Alexandru Sotcan, Lucian-Marius-Florin Dumitrescu, Lucian-George Eftimie, Cezar-Ionut Calin, Mihaela Iordache, Dragos Cuzino, Mara Carsote, Claudiu Nistor, Ana-Maria Radu
Format: Article
Language:English
Published: MDPI AG 2024-08-01
Series:Life
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Online Access:https://www.mdpi.com/2075-1729/14/9/1095
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author Mihai-Lucian Ciobica
Bianca-Andreea Sandulescu
Mihai Alexandru Sotcan
Lucian-Marius-Florin Dumitrescu
Lucian-George Eftimie
Cezar-Ionut Calin
Mihaela Iordache
Dragos Cuzino
Mara Carsote
Claudiu Nistor
Ana-Maria Radu
author_facet Mihai-Lucian Ciobica
Bianca-Andreea Sandulescu
Mihai Alexandru Sotcan
Lucian-Marius-Florin Dumitrescu
Lucian-George Eftimie
Cezar-Ionut Calin
Mihaela Iordache
Dragos Cuzino
Mara Carsote
Claudiu Nistor
Ana-Maria Radu
author_sort Mihai-Lucian Ciobica
collection DOAJ
description The COVID-19 pandemic brought into prominence several emergent medical and surgical entities, but, also, it served as trigger and contributor for numerous apparently unrelated ailments such as arterial and venous thromboembolic complications. Additional risk factors for these thrombotic traits may be concurrent (known or unknown) malignancies, including at hepatic level. Among these, cholangiocarcinoma (CCA), a rare cancer of intra- and extra-hepatic biliary ducts, represents a very aggressive condition that typically associates local and distant advanced stages on first presentation requiring a prompt diagnosis and a stratified management. This neoplasia has been reported to present a large spectrum of paraneoplastic syndromes in terms of dermatologic, renal, systemic, neurologic, endocrine, and cardiovascular settings, that, overall, are exceptional in their epidemiologic impact when compared to other cancers. Our aim was to introduce a most unusual case of CCA-associated distant thrombosis in a male adult who initially was considered to experience COVID-19-related thrombotic features while having a history of obesity and bariatric surgery. This is a hybrid type of paper: this clinical vignette is accompanied by two distinct sample-focused analyses as a basis for discussion; they each had different methods depending on their current level of statistical evidence. We only included English-published articles in PubMed, as follows: Firstly, we conducted a search of reports similar to the present case, regarding distant vein thrombosis in CCA, from inception until the present time. We performed a literature search using the keywords “cholangiocarcinoma”, “thrombosis”, and “Trousseau’s syndrome” and identified 20 cases across 19 original papers; hence, the current level of evidence remains very low Secondly, we searched for the highest level of statistical evidence concerning the diagnosis of venous thrombosis/thromboembolism in patients who underwent COVID-19 infection (key search terms were “COVID-19”, alternatively, “coronavirus”, and “SARS-CoV-2”, and “thrombosis”, alternatively, “thromboembolism”) and included the most recent systematic reviews and meta-analyses that were published in 2024 (from 1 January 2024 until 8 July 2024). After excluding data on vaccination against coronavirus or long COVID-19 syndrome, we identified six such articles. To conclude, we presented a probably unique case of malignancy with an initial manifestation consisting of recurrent superficial vein thrombosis under anticoagulation therapy, with no gastrointestinal manifestations, in a patient with a notable history for multiple episodes of SARS-CoV-2 infection and a prior endocrine (gastric) surgery. To our knowledge, this is the first identification of a CCA under these specific circumstances.
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spelling doaj-art-36abbec107594bf2920eca3cc1fcb9e12025-08-20T01:55:37ZengMDPI AGLife2075-17292024-08-01149109510.3390/life14091095Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19Mihai-Lucian Ciobica0Bianca-Andreea Sandulescu1Mihai Alexandru Sotcan2Lucian-Marius-Florin Dumitrescu3Lucian-George Eftimie4Cezar-Ionut Calin5Mihaela Iordache6Dragos Cuzino7Mara Carsote8Claudiu Nistor9Ana-Maria Radu10Department of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaDepartment of Haematology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, RomaniaDepartment of Pathology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, RomaniaDepartment of Pathology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, RomaniaDepartment of Oncology, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, Romania1st Internal Medicine Department, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, RomaniaLaboratory of Radiology and Medical Imaging II, “Dr. Carol Davila” Central Military University Emergency Hospital, 010825 Bucharest, RomaniaDepartment of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment 4—Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaDepartment of Internal Medicine and Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, RomaniaThe COVID-19 pandemic brought into prominence several emergent medical and surgical entities, but, also, it served as trigger and contributor for numerous apparently unrelated ailments such as arterial and venous thromboembolic complications. Additional risk factors for these thrombotic traits may be concurrent (known or unknown) malignancies, including at hepatic level. Among these, cholangiocarcinoma (CCA), a rare cancer of intra- and extra-hepatic biliary ducts, represents a very aggressive condition that typically associates local and distant advanced stages on first presentation requiring a prompt diagnosis and a stratified management. This neoplasia has been reported to present a large spectrum of paraneoplastic syndromes in terms of dermatologic, renal, systemic, neurologic, endocrine, and cardiovascular settings, that, overall, are exceptional in their epidemiologic impact when compared to other cancers. Our aim was to introduce a most unusual case of CCA-associated distant thrombosis in a male adult who initially was considered to experience COVID-19-related thrombotic features while having a history of obesity and bariatric surgery. This is a hybrid type of paper: this clinical vignette is accompanied by two distinct sample-focused analyses as a basis for discussion; they each had different methods depending on their current level of statistical evidence. We only included English-published articles in PubMed, as follows: Firstly, we conducted a search of reports similar to the present case, regarding distant vein thrombosis in CCA, from inception until the present time. We performed a literature search using the keywords “cholangiocarcinoma”, “thrombosis”, and “Trousseau’s syndrome” and identified 20 cases across 19 original papers; hence, the current level of evidence remains very low Secondly, we searched for the highest level of statistical evidence concerning the diagnosis of venous thrombosis/thromboembolism in patients who underwent COVID-19 infection (key search terms were “COVID-19”, alternatively, “coronavirus”, and “SARS-CoV-2”, and “thrombosis”, alternatively, “thromboembolism”) and included the most recent systematic reviews and meta-analyses that were published in 2024 (from 1 January 2024 until 8 July 2024). After excluding data on vaccination against coronavirus or long COVID-19 syndrome, we identified six such articles. To conclude, we presented a probably unique case of malignancy with an initial manifestation consisting of recurrent superficial vein thrombosis under anticoagulation therapy, with no gastrointestinal manifestations, in a patient with a notable history for multiple episodes of SARS-CoV-2 infection and a prior endocrine (gastric) surgery. To our knowledge, this is the first identification of a CCA under these specific circumstances.https://www.mdpi.com/2075-1729/14/9/1095cholangiocarcinomaliverthrombosisparaneoplastic syndromesurgeryCOVID-19
spellingShingle Mihai-Lucian Ciobica
Bianca-Andreea Sandulescu
Mihai Alexandru Sotcan
Lucian-Marius-Florin Dumitrescu
Lucian-George Eftimie
Cezar-Ionut Calin
Mihaela Iordache
Dragos Cuzino
Mara Carsote
Claudiu Nistor
Ana-Maria Radu
Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
Life
cholangiocarcinoma
liver
thrombosis
paraneoplastic syndrome
surgery
COVID-19
title Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
title_full Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
title_fullStr Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
title_full_unstemmed Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
title_short Superficial Vein Thrombosis in an Asymptomatic Case of Cholangiocarcinoma with Recent History of COVID-19
title_sort superficial vein thrombosis in an asymptomatic case of cholangiocarcinoma with recent history of covid 19
topic cholangiocarcinoma
liver
thrombosis
paraneoplastic syndrome
surgery
COVID-19
url https://www.mdpi.com/2075-1729/14/9/1095
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