Cerebral infarctions as manifestation of ovarian clear cell carcinoma: report of two cases and review of the literature

Venous thromboembolic events (VTE) may occur before the diagnosis of cancer, and VTE can be a predictor of the subsequent diagnosis of cancer. Stroke as well as VTE may be the first manifestation of a subsequent diagnosis of cancer. We report two cases of patients showing cerebral infarction as the first manifestation of clear cell carcinoma of the ovary. The first case is a 55-year-old woman, who had no significant past medical history, lost her consciousness and was diagnosed with bilateral thalamic infarction according to magnetic resonance imaging results. After the diagnosis of infarction, advanced ovarian clear cell carcinoma was diagnosed at the interval of 4 months. Although an operation for ovarian cancer and 6 cycles of subsequent chemotherapies were executed, a recurrent disease occurred in the abdominal cavity. There also were relapses of infarction accompanied by ovarian cancer progression, and she died of ovarian cancer. The second case was a 62-year-old woman, who had repeated infarction episodes, and at the second infarction episode, her respiratory state also worsened. Computed tomography demonstrated swelling of her left ovary, venous thrombosis in the left femoral vein, and pulmonary arterial embolism. An operation for ovarian cancer was performed and early stage clear cell adenocarcinoma of the left ovary was confirmed by pathology. She has remained without evidence of recurrent cancer for 2 years after the completion of chemotherapy. Once cerebral infarction is diagnosed, a comprehensive search for unknown malignant disease should be performed, particularly ovarian clear cell carcinoma.