A Case Series Of Non-Bacterial Thrombotic Endocarditis Associated With Gynecological Malignancies (P6.248)

Objective: To describe three patients presenting with ischemic strokes secondary to non-bacterial thrombotic endocarditis (NBTE) associated with gynecological malignancies. Background: Ischemic stroke secondary to NBTE is a rare complication of systemic malignancies. These strokes are most commonly associated with adenocarcinomas, in particular lung and gastro-intestinal, and lymphoma. Although previously reported in gynecological cancers, this occurrence is infrequent. Furthermore, stroke pre-dating the gynecological malignancy diagnosis has rarely been reported. Design/Methods: Case presentations and literature review. Results: Case1: A 48-year-old woman presented with acute dysarthria and left facial weakness. A Computerized Tomography (CT) head scan showed a right middle cerebral artery (MCA)infarct. Mitral valve vegetations were found on a transthoracic echocardiogram (TTE). A malignancy screen uncovered a large pelvic mass that was subsequently characterized as grade III endometrial adenocarcinoma. Case 2: A 49-year-old woman developed acute right hand weakness. A CT head scan showed an infarct in the left pre-central gyrus. Her trans-esophageal echocardiogram (TEE) revealed aortic valve vegetations. An ovarian tumor was discovered on malignancy work-up and later described as a grade III serous neoplasm. Case 3: A 36-year-old woman with a known diagnosis of 1B cervical squamous cell carcinoma developed acute left sided weakness and decreased level of consciousness. A CT head scan showed a large right MCA stroke. Aortic valve vegetations were seen on TTE. Multiple sets of blood cultures were negative in all three cases. Conclusions: NBTE is an important ischemic stroke mechanism. We have reported three cases where the underlying malignancy was gynecological (endometrial, ovarian, and cervical). In the first two cases, the malignancy was discovered during the investigations for the stroke mechanism, while the third had a known underlying malignancy. This series highlights the need to consider gynecological malignancies as an underlying cause of stroke in young women; and that the ischemic event can occur prior to the malignancy diagnosis. Disclosure: Dr. Schabas has nothing to disclose. Dr.Teal has received personal compensation for activities with AstraZeneca, Abbott, Novartis, Pfizer Inc., Sanofi-Aventis Pharmaceuticals Inc., Novo-Nordisk, Eli Lilly & Co., GlaxoSmithKline Inc., and Roche Diagnostics Corp. as a consultant. Dr.Teal has received research support from AstraZeneca, Pfizer Inc., and Sanofi-Aventis Pharmaceuticals Inc. Dr. Yip has nothing to disclose. Dr. Mann has received personal compensation for activities with EMD Serono.