Paget-Schröetter syndrome as the first symptom of malignant disease: Report of two patients

Abstract

Introduction: Deep venous thrombosis of the upper extremity (UEDVT) is rare and represents 1-2% of all deep venous thrombosis (DVT). UEDVT was first described by Sir Paget (1875) and von Schröetter (1884), and was named Paget-Schröetter syndrome. Malignancy is one of the most common causes of UEDVT cited in literature. Objective: To review patients with UEDVT as the first symptom of malignant disease. Report of the first patient: A 60 year old female presented to our hospital (Surgery Department) with left upper limb swelling and pain appearing two days before hospital admission. Doppler-sonography registered a hyperechogenic thrombotic mass in the left subclavian, axillary and brachial vein. Because of suspected malignancy, additional diagnostic methods were performed. Gastroscopy showed a large tumour localised in the gastric corpus, and a biopsy was taken. Histopathological examination verified a gastric adenocarcinoma. Report of the second patient: A 62 year old man presented to our hospital (Surgery Department) with upper limb swelling and pain appeared three days before hospital admission. Doppler-sonography registered a thrombotic mass in the left internal jugular and subclavian vein. Because of suspected malignancy, additional diagnostic methods were performed. Abdominal et pelvic ultrasound examination showed an enlarged prostate. PSA was significantly increased. Transperineal prostate biopsy was done and the histopathological examination verified an invasive adenocarcinoma of the prostate. Conclusion: In patients with DVT, especially in the case of UEDVT, one should always suspect a potential paraneoplastic syndrome and do additional diagnostic methods to screen for it. This pathological condition is often the first symptom of malignant disease.