VA Resident Report: What is the association between squamous cell carcinoma and acquired factor VIII?

Following surgery for the patient in this case study, the tumor nor the coagulation inhibitor has recurred after 6 months’ follow-up. While it is possible that the inhibitor may have remitted spontaneously or remained in remission because of the therapy given before surgery, the inhibitor’s appearance as the tumor grew and the remission of the tumor as well as of the inhibitor after surgery suggest a causal relationship. As with other factor VIII inhibitors seen with other types of malignancy, it is very unlikely that the tumor was producing the antibody but rather that the tumor induced an autoimmune reaction in the patient.

Shastri, K., Logue, G., Zeid, M., Behrens, A., Lenahan, E., & Haar, J. (n.d.). Acquired factor VIII inhibitor with squamous cell cancer of the epiglottis. Archives of Otolaryngology–head & Neck Surgery., 116(3), 350-353.

A variety of malignancies have been associated with acquired factor VIII inhibitors, including lymphoproliferative diseases6-7 and solid tumors such as those of lung,8 prostate,9 colon,5 and kidney.5 The patient described here developed the acquired inhibitor in conjunction with head and neck carcinoma, specifically squamous cell carcinoma of the epiglottis. This specific association has not been previously reported, to our knowledge. Approximately 12 weeks before the discovery of the head and neck malignancy, the patient had a normal coagulation profile. When the malignancy was discovered, her APTT had risen to approximately twice the normal. Further in vitro testing, described above, documented an IgG antibody that inhibited factor VIII function.

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