Key result
Mechanical thrombectomy identifies paradoxical colorectal tumor embolism via patent foramen ovale.
Why the study?
The mechanism of cerebral tumor embolism from colorectal cancer via a patent foramen ovale was not well characterized.
Case Report (n=1)
No
Pathological analysis of thrombi retrieved during mechanical thrombectomy can identify occult malignancies causing paradoxical cerebral tumor embolism via a PFO.
Embolus histology in thrombectomy may detect occult malignancy; leaves open systematic PFO evaluation in cancer-related stroke.
A 56-year-old woman presented with an acute cerebral embolism. Mechanical thrombectomy retrieved a white embolus, and a pathological examination revealed a tumor fragment consistent with colorectal carcinoma. Imaging revealed no liver or lung metastases, but it identified a patent foramen ovale and pulmonary embolism, suggesting a paradoxical embolic pathway. Given the size of the tumor fragment, passage through the hepatic or pulmonary microcirculation would be difficult to explain given the size of the tumor fragment. These findings suggest venous invasion with direct entry of tumor material into the circulation, followed by right-to-left shunting, which resulted in a cerebral embolism.
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Kobayashi et al. (2026) conducted a case report in Acute cerebral embolism (stroke) (n=1). Mechanical thrombectomy was evaluated. Mechanical thrombectomy retrieved a colorectal carcinoma tumor fragment, revealing a paradoxical embolic pathway via a patent foramen ovale in a 56-year-old woman.
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