Secondary Immune Thrombocytopenic Purpura in Renal Cell Cancer: A Paraneoplastic Syndrome

Abstract

Secondary immune thrombocytopenic purpura (ITP) as a paraneoplastic syndrome has been reported in literature. It is commonly associated with chronic lymphocytic leukemia (CLL) and hodgkins lymphoma. Its association with solid malignancies, especially renal cell cancer is rare, with only a few documented case reports. Treatment usually consisted of targeting the underlying malignancy or utilization of steroid and intravenous immunoglobulin (IVIG) to improve thrombocytopenia. Here, we describe a case of a 75-year-old man with renal cell cancer (RCC), who presented with secondary thrombocytopenia treated with steroid and IVIG. It is important to keep RCC in differential diagnosis for causes for secondary ITP as this impacts treatment.

Keywords: immune thrombocytopenic purpura; paraneoplastic syndrome; renal cell cancer.

Figure 1. Solid sheet and nest of tumor occupying the bone marrow

Pleomorphic and enlarged nuclei, delicate chromatin, visible nucleoli, and abundant eosinophilic cytoplasm can be observed.

Figure 2. Immuno-histochemical stains AE1/AE3 compatible with renal cell carcinomas

Figure 3. Immuno-histochemical stains CK7 compatible with renal cell carcinomas

Figure 4. Immuno-histochemical stains PAX-8 compatible with renal cell carcinomas