Radan Keil1, Jana Koželuhová2, Jiří Dolina3, Aleš Hep3, Radek Kroupa3, Vladimír Kojecký4, Tomáš Krejčí5, Jan Havlín6, Ivana Hadačová7, Jitka Segethová7, Petra Koptová1, Zdena Zádorová8, Jan Matouš8, Barbora Frýbová9, Petr Chmátal1, Martin Wasserbauer1, Jan Šťovíček1, Melvin Bae1, Tolga Guven1, Mahmood Zaeem1, Štěpán Hlava1. 1. Department of Internal Medicine, Motol University Hospital, Prague, Czech Republic. 2. Department of 1st Internal Medicine, University Hospital Pilsen, Pilsen, Czech Republic. 3. Department of Internal Medicine, University Hospital in Brno, Brno, Czech Republic. 4. Department of Internal Medicine, Tomas Bata Regional Hospital in Zlin, Czech Republic. 5. Department of Surgery, Motol University Hospital, Prague, Czech Republic. 6. 3rd Department of Surgery, Motol University Hospital, Prague, Czech Republic. 7. Department of Hematology, Motol University Hospital, Prague, Czech Republic. 8. 2nd Department of Internal Medicine, 3rd Faculty of Medicine, Charles University in Prague, University Hospital Královské Vinohrady, Czech Republic. 9. Departement of Pediatric Surgery, University Hospital Motol, Prague, Czech Republic.
Abstract
Background: Portal vein thrombosis (PVT) is a partial or complete thrombotic occlusion of the portal vein and is rare in noncirrhotic patients.Patients and methods: 78 adult patients with noncirrhotic acute PVT without known malignity were evaluated. Patients with initial CRP level 61-149 mg/l were excluded. Results: Patients were divided into two groups - the first one (33 patients) was characterized with signs of inflammation and CRP over 149 mg/l. The second group (45 patients) was without signs of inflammation and CRP level less than 61 mg/l. The frequency of prothrombotic hematologic factors was statistically significantly different in levels of factor VIII and MTHFR 677 C mutation. All patients from both groups underwent the same oncologic and hemato-oncologic screening which was positive in 23 patients (51.1%) in the group without signs of inflammation. In the group of patients with clinical and laboratory signs of inflammation oncologic and hemato-oncologic screening was positive only in 1 patient (3.0%). Complete portal vein recanalization was achieved in 19.2%, partial recanalization in 26.9%.Conclusions: Patients with clinical signs of inflammation and acute PVT have a low risk of malignancy in contrast to patients without signs of inflammation and acute PVT, which have a high risk of oncologic or hemato-oncologic disease. Patients with negative hemato-oncologic screening should be carefully observed over time because we expect they are at higher risk for the development of hemato-oncologic disease, independent from the presence and number of procoagulation risk factors.
Background: Portal vein thrombosis (PVT) is a partial or complete thrombotic occlusion of the portal vein and is rare in noncirrhotic patients.Patients and methods: 78 adult patients with noncirrhotic acute PVT without known malignity were evaluated. Patients with initial CRP level 61-149 mg/l were excluded. Results:Patients were divided into two groups - the first one (33 patients) was characterized with signs of inflammation and CRP over 149 mg/l. The second group (45 patients) was without signs of inflammation and CRP level less than 61 mg/l. The frequency of prothrombotic hematologic factors was statistically significantly different in levels of factor VIII and MTHFR 677 C mutation. All patients from both groups underwent the same oncologic and hemato-oncologic screening which was positive in 23 patients (51.1%) in the group without signs of inflammation. In the group of patients with clinical and laboratory signs of inflammation oncologic and hemato-oncologic screening was positive only in 1 patient (3.0%). Complete portal vein recanalization was achieved in 19.2%, partial recanalization in 26.9%.Conclusions: Patients with clinical signs of inflammation and acute PVT have a low risk of malignancy in contrast to patients without signs of inflammation and acute PVT, which have a high risk of oncologic or hemato-oncologic disease. Patients with negative hemato-oncologic screening should be carefully observed over time because we expect they are at higher risk for the development of hemato-oncologic disease, independent from the presence and number of procoagulation risk factors.