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DOI: 10.1055/s-0042-1748441
Breast cancer, subclavian port catheter and controlled ovarian stimulation (COS): a case report highlighting a challenging combination for fertility protection
Aims This report points to an elevated risk of thromboembolism in a breast cancer patient, who, in preparation of neoadjuvant chemotherapy, received a port catheter. For fertility protection, COS and oocyte retrieval was planned. This combination of prothrombotic risk factors ought to be considered for LMWH-prophylaxis.
Material, methods We report on a 39-year-old nulliparous woman with HR+/HER2- early breast cancer (cT1c, cN0, G3, Ki67 60%, cM0). BMI was normal, no personal or family-related risk factors were known. Ovarian reserve was poor (AFC 5, AMH 0.63ng/ml). In preparation for neoadjuvant chemotherapy, a port catheter was implanted in the left subclavian vein; the procedure was uneventful. For fertility protection, she was started on COS using an antagonist protocol (rec-FSH, HMG, Ganirelix) in combination with letrozole given her HR-positive cancer. Ten days later she presented with pain and heaviness of her left arm; estradiol-level was 347pg/ml at this time.
Results Doppler-sonography revealed a thrombosis of the port catheter; consequently, anticoagulation with LMWH was started in a therapeutic dosage. Despite this event, ovulation was induced with a GnRH-trigger and ultrasound-guided oocyte retrieval was performed. A total of three metaphase-II-oocytes was vitrified. On the following day the first cycle of neoadjuvant chemotherapy was administered complication-free using the port catheter. Therapeutic anticoagulation was continued for three months.
Summary This case highlights the relevance of a combination of several prothrombotic effects: cancerous disease, venous access device and supraphysiologic estradiol concentrations caused by COS. In such cases, adequate prophylactic measures should be considered even without further risk factors.
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Ich erkläre als korrespondierender Autor, dass meine Koautoren mir mitgeteilt haben, dass sie während der letzten 3 Jahre keine wirtschaftlichen oder persönlichen Verbindungen im oben genannten Sinne hatten. Auch ich selbst hatte keine derartigen Verbindungen in den letzten 3 Jahren.
Publication History
Article published online:
21 June 2022
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