Trousseau's Syndrome Research Articles

Survival from cancer of the pancreas in England and Wales up to 2001.

Survival from cancer of the pancreas in England and Wales up to 2001.

"HIT on Trousseau" Double trouble: acquired coagulopathy with femoral artery thrombosis

Trousseau Syndrome is a paraneoplastic procoagulant phenomenon. Heparin-induced thrombocytopenia (HIT) is a rare complication of anticoagulation with heparin. To our knowledge, the coincidence of the two has not been reported so far. We report a case of an acute thrombosis of the left femoral artery and distal leg arteries in a patient with an otherwise normal cardiovascular status. Endovascular revascularization attempts using mechanical rotational thrombectomy catheter, aspiration and local thrombolysis were unsuccessful. Progressive coagulation along the intra-arterial catheter was seen. Surgical thrombectomy of the femoral-pedal axis was successful, but the patient developed an immune-mediated HIT postoperatively. An adenocarcinoma of the colon was the likely cause for the initial arterial thrombosis, and probably adversely affected endovascular revascularization attempts. Subsequent HIT with microvascular thrombosis worsened ischemic damage leading to a below knee-amputation, despite patent large vessels. Compared to venous thrombosis, arterial thrombosis is a rare manifestation of Trousseau syndrome. The coincidence of it with HIT is even rarer. There may be a causal relationship between the two.

Tromboflebitis superficial migratoria: revisión clínica e histológica de 8 casos

IntroductionSuperficial migratory thrombophlebitis (SMT) or thrombophlebitis migrans is characterized by recurrent episodes of localized thrombosis of the superficial veins in the limbs and trunk. It has been associated with various systemic diseases that should be taken into consideration when assessing the patient. Material and methodsBetween 1997 and 2007, 8 patients with SMT were seen at Hospital General Universitario de Valencia in Valencia, Spain. We review the clinical features and histopathology, along with the associated diseases. ResultsThe most common clinical presentation was with painful nodules mimicking erythema nodosum on the lower extremities. Other sites were on the abdomen and trunk. Only in 1 case was SMT diagnosed clinically. In other cases, the clinical diagnoses were cellulitis, lymphangitis, nodular vasculitis, and panarteritis nodosa. The histologic characteristics were compatible with superficial thrombophlebitis, and orcein staining revealed the internal elastic lamina to be absent in all cases. No evidence of an occult tumor was found in any of the cases. Two cases had a history of Buerger disease and in another the condition presented in association with a fever of unknown origin. ConclusionThe possible association of SMT with systemic diseases, including cancer, makes its diagnosis important. In our case series we did not find evidence of associated disease in the majority of cases. However, since cancer can manifest months and even years after the appearance of SMT, follow-up is necessary in these patients.

Bilateral Phlegmasia Dolens Associated With Trousseau's Syndrome: A Case Report

Hasegawa S, Aoyama T, Kakinoki R, Toguchida J, Nakamura T. Bilateral phlegmasia dolens associated with Trousseau's syndrome: a case report. Phlegmasia dolens is a rare disorder caused by massive venous thrombosis. The clinical condition is subclassified as phlegmasia cerulea dolens (PCD) and phlegmasia alba dolens. The 2 forms differ in the venous area affected and remaining blood flow, causing arterial involvement and resulting in a difference in therapeutic strategy and prognosis. In PCD, the mortality rate is high, and amputation for venous gangrene is needed. Phlegmasia alba dolens is a mild form of PCD; the collateral venous system is intact, and the prognosis is better than for PCD. We experienced a rare case of bilateral phlegmasia dolens associated with Trousseau's syndrome. The patient was diagnosed with phlegmasia alba dolens because the artery was not occluded. She was treated with anticoagulant therapy, the placement of a vena cava filter, and a rehabilitation program. The bilateral soleus muscles underwent necrosis, and the occurrence of equinus foot disturbed her walking, but careful rehabilitation with stretching, a range of passive motion exercises by a physical therapist, a tilting table, and ergometer training strengthened the muscles and allowed the patient to walk unaided 8 months after onset. Through this case, we hope to learn more about the pathogenesis of phlegmasia dolens and clinical treatment measures.

Thrombose et cancer bronchique

This relation is sometimes described as a double association: venous thromboembolism (VTE) can reveal cancer (so-called Trousseau syndrome), but cancer and its treatment are also risk factors for VTE. Lung cancer, frequent and serious, is one of the greatest purveyors of VTE, a disease that pneumologists and oncologists must often confront in diagnosis, prevention, and treatment. This article investigates the epidemiological, prevention, and treatment aspects of VTE in cancer patients, particularly those with lung cancer, but also discusses diagnostic specificities and, briefly, the possible antitumor effect of heparins.

Cancer occulte et maladie thromboembolique veineuse : quelle enquête étiologique devant une maladie thromboembolique veineuse inaugurale ?

The association between thrombosis and cancer, initially evidenced in metastatic patients is well recognized and now described in patients with occult cancer where venous thrombosis may be the first clinical manifestation (Trousseau's syndrome). In this review, clinical and epidemiological interactions between thrombosis and cancer are described in five distinct step: venous thrombosis during malignancy and occult cancer, period of large increased in the risk for diagnosis of cancer, patients or venous thrombosis with increased risk for occult cancer, extensive or not extensive screening for occult cancer, earlier occult cancer detection associated or not with improved treatment possibilities and thus prognosis.

Diverse Roles of Tissue Factor–Expressing Cell Subsets in Tumor Progression

Oncogenic upregulation of tissue factor (TF) and release of TF-containing microvesicles play an important role in cancer-related coagulopathy (Trousseau's syndrome), angiogenesis, and disease progression. In addition, certain types of host cells (stromal cells, inflammatory cells, activated endothelium) may also express TF. Although the relative contribution of host-related versus tumor-related TF to tumor progression is not known, our recent studies indicate that the role of both sources of TF in tumor formation is complex and context-dependent. Disruption of TF expression/activity in cancer cells leads to tumor growth inhibition in immunodeficient mice, even in cases where TF overexpression is driven by potent oncogenes ( K-RAS or EGFR). Interestingly, TF expression in vivo appears to be influenced by many factors, including the level of oncogenic transformation, tumor microenvironment, and differentiation from cancer stem-like cells. We postulate that activation of TF signaling and coagulation may deliver growth-promoting stimuli (e.g., fibrin, thrombin, platelets) to dormant cancer stem cells (CSCs). Functionally, these influences may be tantamount to formation of a provisional (TF-dependent) cancer stem cell niche. As such, these changes may contribute to the involvement of CSCs in tumor growth, angiogenesis, and metastasis.

Superficial Migratory Thrombophlebitis: A Clinical and Histologic Review of 8 Cases

Introduction Superficial migratory thrombophlebitis (SMT) or thrombophlebitis migrans is characterized by recurrent episodes of localized thrombosis of the superficial veins in the limbs and trunk. It has been associated with various systemic diseases that should be taken into consideration when assessing the patient. Material and methods Between 1997 and 2007, 8 patients with SMT were seen at Hospital General Universitario de Valencia in Valencia, Spain. We review the clinical features and histopathology, along with the associated diseases. Results The most common clinical presentation was with painful nodules mimicking erythema nodosum on the lower extremities. Other sites were on the abdomen and trunk. Only in 1 case was SMT diagnosed clinically. In other cases, the clinical diagnoses were cellulitis, lymphangitis, nodular vasculitis, and panarteritis nodosa. The histologic characteristics were compatible with superficial thrombophlebitis, and orcein staining revealed the internal elastic lamina to be absent in all cases. No evidence of an occult tumor was found in any of the cases. Two cases had a history of Buerger disease and in another the condition presented in association with a fever of unknown origin. Conclusion The possible association of SMT with systemic diseases, including cancer, makes its diagnosis important. In our case series we did not find evidence of associated disease in the majority of cases. However, since cancer can manifest months and even years after the appearance of SMT, follow-up is necessary in these patients.

Superior Vena Cava Syndrome Caused by an Intravascular Thrombosis Due to Underlying Prostate Carcinoma

Superior vena cava (SVC) syndrome is usually caused by malignant tumors or their lymph node metastases oppressing a SVC. However, we encountered a case of SVC syndrome that was caused by a thrombus in the SVC, which we considered as a manifestation of Trousseau's syndrome triggered by underlying prostate cancer. A 60-year-old man patient complained of facial swelling. Physical examinations suggested SVC syndrome; enhanced CT and MRI demonstrated the presence of thrombus in the SVC accompanied by multiple mediastinal and axillary lymph node swelling. Histological examination of both percutaneous transluminally aspirated thrombus via a catheter through jugular vein and the axillary lymph nodes included metastatic prostate cancer. Although the ultrasonic and MR images were not compatible with the prostate cancer, needle biopsies from the prostate established the diagnosis. The SVC syndrome as an initial manifestation of underlying unknown malignancy and also due to intravascular thrombosis caused by cancer metastasis to the vascular wall is extremely uncommon.

Utilization Of Ventilation / Perfusion Lung Scan In A Cancer Hospital

Utilization Of Ventilation / Perfusion Lung Scan In A Cancer Hospital

Acute Pulmonary Embolism and Occult Lung Adenocarcinoma: A Case Report of Trousseau's Syndrome

In patients with underlying malignancy, systemic venous thromboembolism (VTE) is a common complication in the cancer-related hypercoagulable state. Under certain circumstances, systemic VTE may be the only presentation before cancer is diagnosed. Acute pulmonary embolism (PE) is a severe form of systemic VTE. Its symptoms manifest from asymptomatic state, dyspnea, chest pain, and syncope, to sudden circulatory collapse. Acute PE is a less common diagnostic entity in Asian countries than in Western countries. In addition, patients with acute PE seem to have a higher cancer occurrence than those with other mild VTE presentations. This population difference leads to an underestimation, and therefore, delays in the early detection of an occult cancer. Herein, we report a 54-year-old man who was admitted due to acute PE. He was finally diagnosed with lung adenocarcinoma with multiple liver and bony metastasis. However, he had symptoms related to acute PE only, and no cancer-related complaints were noted. Based on this unusual case experience, we suggest a detailed search for occult malignancy is crucial to prevent a delayed diagnosis in patients presenting with acute PE without a known etiology of thrombosis.

Prenatal diagnosis of mosaicism for 11q terminal deletion

The phenotype of 11q terminal deletion also known as Jacobsen syndrome is a clinically well known entity whose diagnosis in infancy and childhood is based on clinical examination, hematological and cytogenetic findings. Hematological features in Jacobsen syndrome are very similar to those reported in Paris–Trousseau syndrome (PTS) which is also associated with11q terminal deletion. Karyotype analysis shows a variable terminal deletion from 11q23 sub-band extending to the telomere. Most often in patients with Jacobsen syndrome, this chromosomal deletion is present in all metaphases. We report on the identification of a distal 11q deletion in mosaic (20% of deleted cells) in a fetus ascertained after amniocentesis for maternal serum screening test indicative for Down syndrome. The present case is the third prenatal diagnosis of a mosaic for a distal 11q deletion with the lowest mosaicism rate. The 2D-ultrasound examination and cord blood hematological studies were useful to estimate the prognosis at term, considering the contribution of the mosaicism rate to the phenotypic variability in Jacobsen syndrome. The identification of mosaicism for distal 11q deletion is a very rare event in prenatal diagnosis. This case illustrates the complexity in genetic counselling for prenatally ascertained partial monosomy 11qter in mosaic.

Superficial migratory thrombophlebitis in a hypertensive patient: response to antihypertensive therapy

Journal of the European Academy of Dermatology and VenereologyVolume 22, Issue 3 p. 383-384 Superficial migratory thrombophlebitis in a hypertensive patient: response to antihypertensive therapy C Laguna, C Laguna Department of Dermatology, Valencia University General Hospital, Valencia, Spain, Corresponding author, Department of Dermatology, Valencia University General Hospital, Avenue Tres Cruces s/n 46014-Valencia, Spain, tel. +961972000; fax +961972130; E-mail: cecipru@comv.esSearch for more papers by this authorA Pérez-Ferriols, A Pérez-Ferriols Department of Dermatology, Valencia University General Hospital, Valencia, Spain, Corresponding author, Department of Dermatology, Valencia University General Hospital, Avenue Tres Cruces s/n 46014-Valencia, Spain, tel. +961972000; fax +961972130; E-mail: cecipru@comv.esSearch for more papers by this authorV Alegre, V Alegre Department of Dermatology, Valencia University General Hospital, Valencia, Spain, Corresponding author, Department of Dermatology, Valencia University General Hospital, Avenue Tres Cruces s/n 46014-Valencia, Spain, tel. +961972000; fax +961972130; E-mail: cecipru@comv.esSearch for more papers by this author C Laguna, C Laguna Department of Dermatology, Valencia University General Hospital, Valencia, Spain, Corresponding author, Department of Dermatology, Valencia University General Hospital, Avenue Tres Cruces s/n 46014-Valencia, Spain, tel. +961972000; fax +961972130; E-mail: cecipru@comv.esSearch for more papers by this authorA Pérez-Ferriols, A Pérez-Ferriols Department of Dermatology, Valencia University General Hospital, Valencia, Spain, Corresponding author, Department of Dermatology, Valencia University General Hospital, Avenue Tres Cruces s/n 46014-Valencia, Spain, tel. +961972000; fax +961972130; E-mail: cecipru@comv.esSearch for more papers by this authorV Alegre, V Alegre Department of Dermatology, Valencia University General Hospital, Valencia, Spain, Corresponding author, Department of Dermatology, Valencia University General Hospital, Avenue Tres Cruces s/n 46014-Valencia, Spain, tel. +961972000; fax +961972130; E-mail: cecipru@comv.esSearch for more papers by this author First published: 12 July 2007 https://doi.org/10.1111/j.1468-3083.2007.02337.xCitations: 3 DOI: 10.1111/j.1468-3083.2007.02337.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue3March 2008Pages 383-384 RelatedInformation

Trousseau Syndrome Due to Pleural Mesothelioma

Thrombosis involving a brain infarction frequently occurs in patients with a malignant tumor. Although nearly all types of tumor have been reported in association with a hypercoagulable state, pleural mesothelioma-associated Trousseau syndrome is extremely rare. A 69-year-old female was admitted to our hospital with cough, sputum, and breathing difficulties. She was diagnosed as having a mesothelioma from a percutaneous pleural biopsy. Although there were no risk factors for atherosclerosis, brain infarctions showed frequent relapses, even under anticoagulant therapy, and there was a marked hypercoagulable state. Attention should be paid to this syndrome when unexplained brain infarctions occur in patients with pleural mesothelioma.

Thrombophlebitis migrans as a footprint of Buerger’s disease: a prospective–descriptive study in north-east of Iran

The pathogenesis of thrombophlebitis migrans is as unknown as the etiology of Buerger's disease (BD). In the past, thrombophlebitis migrans was a major criterion used in the diagnosis of BD, whereas today it is not as important as before and it is often forgotten to be asked about from patients with BD. In this project, during a 22-month prospective study on 86 patients suffering from BD, 65.4% had the history or sign of thrombophlebitis migrans, which in 25.6% of them, it was the first presentation of the disease and in 4.7% of them, it was the main cause of complaint. Thrombophlebitis migrans had initially occurred 9 years before the patient showed any sign of the disease (with the time range of a maximum of 22 years and a minimum of 4 months). In 45% of patients who had recommenced cigarette smoking, thrombophlebitis migrans occurred about 1-4 months before the new onset of their acute ischemic signs. Superficial thrombophlebitis migrans can be considered as a warning sign for BD onset in Asian young male smokers. With regard to the variety in the clinical feature and localization of appearance of thrombophlebitis migrans in the studied patients and its unknown pathogenesis, there should be more studies and researches toward understanding the nature of BD and thrombophlebitis migrans as its footprint.

Internal jugular vein thrombosis due to distant malignancies: two case reports and literature review

The internal jugular vein is an uncommon site of spontaneous venous thrombosis. Most cases usually result from intravenous drug abuse, jugular vein catheterisation, neck dissection, a hypercoagulable state associated with malignancy (Trousseau's syndrome), neck injury or ovarian overstimulation syndrome. In this paper, we present and discuss two cases of spontaneous jugular vein thrombosis associated with breast and lung malignancies. The possibility of Trousseau's syndrome due to distant malignancy should be considered by otolaryngologists and appropriately investigated.

Inferior vena caval tumor thrombus extending into the right atrium in a patient with pancreatic cancer

Venous thromboembolism is a common complication in patients with cancer and an important cause of morbidity and mortality. Idiopathic thrombosis, migratory or recurrent thrombophlebitis may be the first manifestation of an occult malignancy. While deep venous thrombosis and pulmonary embolism are the most common thrombotic conditions in patients with malignant disease, tumor thrombus may be seen in inferior vena cava, mainly in patients with renal cell carcinoma, hepatocellular carcinoma, testicular tumors or adrenal carcinoma. Although pancreatic cancer is one of the cancers that are most strongly associated with thrombotic complications along with cancers of ovary and brain, there has been no report about presence of thrombus in the inferior vena cava in pancreatic cancer. We report a female patient with pancreatic cancer associated with tumor thrombus extending from the inferior vena cava to the right atrium.

Oncogene-Directed Therapies as Modulators of Cancer Coagulopathy, Angiogenesis and Tumor-Vascular Interface

Oncogenic lesions in the cancer cell genome not only alter the intrinsic properties of cancer cells themselves, but also trigger signaling events, the effects of which impact the relationship between tumors and their surrounding host tissues, including the vascular system. Manifestations of the latter include the onset and progression of tumor angiogenesis, and systemic activation of the hemostatic system, a process also known as cancer coagulopathy, or Trousseau syndrome. Indeed, tumor growth, invasion and metastasis are profoundly affected by the properties of the tumor - vascular interface. We postulated earlier that the link between the expression of cancercausing signaling alterations and cancer coagulopathy is at least twofold. First, cancer coagulopathy may emerge indirectly, as an unspecific consequence of vascular permeability and other features of tumor-associated vascular growth, including the pro- and anticoagulant actions of certain angiogenic mediators, some of which (e.g. VEGF) are direct regulatory targets of oncogenes and tumor suppressors. Second, activated oncogenes (K-ras, EGFR or PML-RARα, MET), and/or inactivation of tumor suppressors (e.g. p53 or PTEN) may deregulate some of the hemostatic proteins more directly, i.e. through changes in expression of tissue factor (TF), plasminogen activation inhibitor 1 (PAI-1) and cyclooxygenase 2 (COX-2) [1-4]. In addition to TF expression and release as plasma microvesieles, mutant K-ras may also upregulate expression of thrombin receptors (PAR-1) by cancer cells, thereby possibly rendering such cells hypersensitive to signals emanating from the hemostatic system (e.g. pericellular thrombin). Here, we present an argument that anti-cancer signal transduction inhibitors, also known as ‘targeted agents’ (e.g. Gleevec, Iressa, Erbitux, ATRA) could modulate various vascular processes in cancer, including angiogenesis and cancer coagulopathy, i.e. act as cancer - specific indirect antiangiogenic agents, possibly with a distinct element of anticoagulant activity.

Stroke as the first manifestation of concealed cancer

Background and purpose Trousseau's syndrome (TS) is defined as a malignancy–related thromboembolism occurring in patients with an underlying or undiagnosed malignancy. Stroke seldom occurs as the first manifestation of a cancer. We investigated the clinical and radiological features of patients with TS. Methods We reviewed the clinical, pathologic, and radiological records of consecutive stroke patients, whose cancers were diagnosed at stroke presentation. Cancer-related stroke was defined if no definite cause was confirmed and malignancy was detected within 6 months of first stroke onset without cancer-related treatment. All patients underwent brain diffusion-weighted MRI (DWI), MR angiography, and echocardiography. The sizes, numbers, and locations of all hyperintense lesions in the DWI were noted. Results Ten patients were finally analyzed. Histologically, cancers were often proven to adenocarcinomas (50%, 5/10) of advanced stage. Six of 10 patients tested (60%) had elevated D-dimer. Seven of the 10 patients (70%) showed bihemispheric anterior and posterior involvement. DWI features showed numerous small and medium or large lesions in multiple territories in 9 patients (90%). Conclusions The authors emphasize that when presented with multiple bihemispheric infarctions on DWI and an unknown etiology, the neurologist must consider the existence of a concealed cancer.

Budd–Chiari syndrome in the course of Behcet's disease: Clinical and laboratory analysis of four cases

Objectives Budd–Chiari syndrome (BCS) is an uncommon manifestation of Behcet's disease (BD) characterized by hepatic venous outflow obstruction either within the liver or in the inferior vena cava (IVC). Clinical and laboratory findings, as well as treatment options and prognosis of four BD patients with BCS, were analyzed retrospectively. Methods Four male patients with BCS due to BD, ranging in age from 22 to 46 (median 24 years), were included in the present study. The presence of BCS was confirmed by Doppler ultrasonography and computed tomography and/or venography. Levels of protein C, protein S, antithrombin III, anticardiolipin antibodies and lupus anticoagulants were evaluated in all patients during the acute stage of BCS and both 6 months and 1 year after. Activated protein C resistance and prothrombin gene mutation were also determined in three patients. Results Two of the four patients with BCS had already been diagnosed with BD, while the other two were diagnosed with concurrent BD and BCS upon their admission to our clinic. All patients had deep venous thrombosis and superficial migratory thrombophlebitis prior to development of BCS. Case 1 died due to hepatic failure 1 month after his admission. The overall health state of the other three patients has remained good thanks to anticoagulation and immunosuppressive treatments. Three of these patients had one or more than one factor predisposing to thrombosis. Conclusions The number of occluded hepatic veins and right hepatic vein involvement, as well as inferior vena cava thrombosis, can be deemed as a major determinant of prognosis. Although the presence of a thrombophilic condition may not be a factor for the clinical prognosis of BCS on its own, it may still necessitate a long-term anticoagulation for prevention of further thrombotic events.