Thrombotic storm with paradoxical embolism in ovarian clear cell carcinoma

Abstract

Cancer-associated thromboembolism remains a significant therapeutic challenge, particularly in ovarian clear cell carcinoma, which is among the most thrombogenic, gynecologic malignancies. We report the case of a 54-year-old woman who developed a catastrophic thrombotic storm shortly after the diagnosis of advanced ovarian clear cell carcinoma. Despite therapeutic anticoagulation, she experienced multiple arterial thromboembolic events, including ischemic stroke, acute upper limb ischemia, and ST-elevation myocardial infarction, possibly due to paradoxical embolism through a patent foramen ovale. Laboratory investigations revealed markedly elevated tumor markers and features of cancer-associated coagulopathy. This case highlights the extreme thrombotic potential of ovarian clear cell carcinoma and underscores the importance of considering paradoxical embolism as a mechanism of arterial events in patients with concurrent venous thrombosis and intracardiac shunting. Early recognition and coordinated multidisciplinary management, including critical care support, are essential in this life-threatening scenario.

Keywords: Cancer-associated thrombosis; Ovarian clear cell carcinoma; Paradoxical embolism; Patent foramen ovale; Thrombotic storm; Venous thromboembolism.