Presentation Title

Ovarian Teratoma Versus Osteosarcoma as a Cause of Immune Thrombocytopenia in a Young Female

Format

Poster

Start Date

6-11-2020 10:15 AM

End Date

6-11-2020 10:30 AM

Abstract

Thrombocytopenia has been associated with ovarian teratoma. The improvement of thrombocytopenia after surgical excision of the teratoma further supports this theory. Any bone marrow disorder can cause thrombocytopenia as well. We present an interesting case of a 35-year-old female who presented with a pelvic mass. She reported pain in pelvis and lower extremities for 4 weeks. Also, she had thrombocytopenia and was initially suspected to have immune thrombocytopenic purpura, for which she was started on steroids. The patient failed to respond to steroids and a bone marrow biopsy was done which showed sarcoma cells. Hematology team was consulted as the platelets kept on dropping to ~5000, despite steroid treatment. She was treated with IVIG, rituximab, platelet transfusions as well as romiplostim, without much benefit. CT abdomen and pelvis showed complex cystic mass consistent with an ovarian teratoma. Surgery to remove the pelvic mass was deferred due to low platelets and the patient was referred to an outpatient cancer center for further management. This rare case raises awareness of the association between ovarian teratoma and immune thrombocytopenia. Reportedly, there might be a peptide secreted by the teratoma cells that is toxic to normal platelets, decreasing their survival. This patient also had osteosarcoma. By overwhelming the bone marrow with tumor cells, the platelet production is hampered which leads to thrombocytopenia in patients with osteosarcoma. Thrombocytopenia in our patient could be related to the ovarian teratoma as well as the osteosarcoma. Further research is needed to highlight the exact mechanism of these associations.

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Nov 6th, 10:15 AM Nov 6th, 10:30 AM

Ovarian Teratoma Versus Osteosarcoma as a Cause of Immune Thrombocytopenia in a Young Female

Thrombocytopenia has been associated with ovarian teratoma. The improvement of thrombocytopenia after surgical excision of the teratoma further supports this theory. Any bone marrow disorder can cause thrombocytopenia as well. We present an interesting case of a 35-year-old female who presented with a pelvic mass. She reported pain in pelvis and lower extremities for 4 weeks. Also, she had thrombocytopenia and was initially suspected to have immune thrombocytopenic purpura, for which she was started on steroids. The patient failed to respond to steroids and a bone marrow biopsy was done which showed sarcoma cells. Hematology team was consulted as the platelets kept on dropping to ~5000, despite steroid treatment. She was treated with IVIG, rituximab, platelet transfusions as well as romiplostim, without much benefit. CT abdomen and pelvis showed complex cystic mass consistent with an ovarian teratoma. Surgery to remove the pelvic mass was deferred due to low platelets and the patient was referred to an outpatient cancer center for further management. This rare case raises awareness of the association between ovarian teratoma and immune thrombocytopenia. Reportedly, there might be a peptide secreted by the teratoma cells that is toxic to normal platelets, decreasing their survival. This patient also had osteosarcoma. By overwhelming the bone marrow with tumor cells, the platelet production is hampered which leads to thrombocytopenia in patients with osteosarcoma. Thrombocytopenia in our patient could be related to the ovarian teratoma as well as the osteosarcoma. Further research is needed to highlight the exact mechanism of these associations.