Trousseau's Syndrome Research Articles

Trousseau's syndrome triggered by an immune checkpoint blockade in a non‐small cell lung cancer patient

PD-1 blockade therapy activates T cells by blocking the interaction between PD-1 and PD-L1 and promotes IFN-γ and Th1 cytokine production. In turn, IFN-γ and Th1 cytokines produced by activated T cells promote TF synthesis in monocytes/macrophages, which results in hypercoagulability leading to thrombosis.

Changes in Serial D-Dimer Levels Predict the Prognoses of Trousseau's Syndrome Patients

Background: The development of acute multiple embolic infarctions (AMEI) resulting from cancer is known as Trousseau's syndrome (TS). At present, however, there is no good marker for predicting the prognosis of TS patients. In the present study, we evaluated the use of serial D-dimer levels as a prognostic marker for TS.Methods: This retrospective cohort study included 1,409 consecutive acute ischemic stroke patients. We selected a group of patients with TS showing AMEI (n = 38; TS group) and a group of patients with atrial fibrillation (Af) and AMEI (n = 35; Af group) as controls. Serial D-dimer levels were measured between days 7 and 28 after stroke (sub-acute phase) in 21 patients of the TS group and 24 patients of the Af group.Results: D-dimer levels at onset (acute phase) were significantly higher in the TS group (8.45 ± 1.79 μg/mL, n = 38) compared with the Af group (1.14 ± 0.14 μg/mL, n = 35) (p < 0.0001). In patients for whom serial D-dimer measurements were made, D-dimer levels measured at the sub-acute phase decreased to 0.48 ± 0.12 μg/mL (n = 24) in the Af group, but remained elevated in the TS group during the sub-acute phase (11.20 ± 2.77 μg/mL, n = 21) (p < 0.0001). In all TS patients in whom serial D-dimer measurements were made, D-dimer levels in 17 patients who died within 500 days (13.31 ± 3.23 μg/mL) were significantly higher than those of the four surviving patients (2.23 ± 0.38 μg/mL) (cut-off D-dimer level = 3.0 μg/mL) during this period. Moreover, serial D-dimer levels of 10 patients who died within 90 days (17.78 ± 4.60 μg/mL) were significantly higher than those of the 11 patients who survived up to 90 days (5.21 ± 2.12 μg/mL) (p < 0.05).Conclusions: Serial D-dimer levels may be a good biomarker for TS as well as a useful predictor of the prognosis of TS patients.

Treatment of EGFR mutation-positive non-small cell lung cancer complicated by Trousseau syndrome with gefitinib followed by osimertinib: a case report.

Malignant tumors can induce a hypercoagulable state known as Trousseau syndrome that increases the risk for venous thromboembolism including disabling cerebral infarction. Anticoagulant therapy without anticancer treatment is not effective for amelioration of this coagulation abnormality. Most patients with lung cancer positive for activating mutations of the epidermal growth factor receptor (EGFR) are sensitive to EGFR tyrosine kinase inhibitors (TKIs), but the efficacy and safety of EGFR-TKIs in such patients with a poor performance status (PS) due to Trousseau syndrome has been unclear. We here describe a patient with EGFR mutation–positive lung cancer who developed disabling cerebral infarction due to Trousseau syndrome. Administration of the EGFR-TKI gefitinib and anticoagulant therapy resulted in a partial tumor response and recovery from both the coagulation abnormality and the severe neurological symptoms. After the development of resistance to gefitinib, the EGFR-TKI osimertinib was safely administered until disease progression without recurrence of the coagulation abnormality. This case suggests that gefitinib followed by osimertinib may be a safe and effective treatment option for patients with EGFR mutation–positive lung cancer who experience disabling cerebral infarction due to Trousseau syndrome.

A Case of Lung Adenocarcinoma Complicated by Trousseau's Syndrome Evaluated by Transthoracic Echocardiography

A Case of Lung Adenocarcinoma Complicated by Trousseau's Syndrome Evaluated by Transthoracic Echocardiography

Panniculitis: rheumatological aspects

Different types of panniculitis (Pn) can be one of the symptoms of rheumatic diseases (RDs). Pn is a group of heterogeneous inflammatory diseases that are characterized by subcutaneous adipose tissue (SAT) lesion and often occur with musculoskeletal and visceral involvements. There is no single concept of the etiology and pathogenesis of Pn. Infections, injures, hormonal and immune disorders, drug intake, pancreatic disease, malignant neoplasms, etc. can play a role in the development of Pn. The latter is associated with RDs in a fairly large group of patients. There have recently been reports of about 200 and 50 cases of only idiopathic lobular Pn in the world and Russian literature, respectively. There have also been publications on other types of Pn, such as erythema nodosum, eosinophilic fasciitis, superficial migratory thrombophlebitis, lupus Pn, dermatomyositis Pn, scleroderma systematica, gout, psoriatic arthritis, etc. There is now a need to study skin changes and SAT lesions in the context of RDs, which will be able to estimate the true clinical and prognostic value of Pn in RDs. Based on recent literature data, this review characterizes the main types of Pn, their clinical and histological signs, and diagnostic methods.

Non-bacterial endocarditis as an initial presentation of a Trousseau's Syndrome? A complex diagnostic challenge. Case report

Introduction: The association between a state of hypercoagulability and neoplasia is well established in the literature. Non-Bacterial Thrombotic Endocarditis (NBTE), characterized by small sterile vegetations (accumulations of fibrin and platelets) deposited on the valvular leoflet, is a rare form of presentation, specially associated with an adenocarcinoma. Their exact prevalence is unknown because still today there is no good method for pre-mortem diagnosis.

Clinical associations of Trousseau's syndrome associated with cerebral infarction and ovarian cancer.

ObjectiveSince there have been few large series studies to date, we investigated the relationship between Trousseau's syndrome associated with cerebral infarction and its clinical associations with ovarian cancer.MethodsIn this study, we investigated the association between cerebral infarction onset and ovarian cancer. Eight-hundred twenty-seven consecutive ovarian cancer patients from 4 affiliated academic institutions were included in the study over a 12 years period. All patients were histopathologically diagnosed as epithelial ovarian cancer and were analyzed retrospectively.ResultsThe 27 patients (3.2%) presented with cerebral infarction during the study period, 14 patients onset prior to treatment (1.7%), and 13 patients onset after start of initial treatment (1.5%). Univariate analysis and multivariate analysis was performed for onset of Trousseau's syndrome and various clinical and pathological parameters. There was no statistical significance between the occurrence of Trousseau's syndrome with age or International Federation of Gynecology and Obstetrics (FIGO) stage; however, univariate analysis and multivariate analysis demonstrated a statistically significant association between clear cell carcinoma (CCC) and non-CCC histology.ConclusionThus, our results demonstrate that Trousseau's syndrome with cerebral infarction occurred with greater incidence among CCC cases compared to non-CCC cases.

The clinical features of 40 patients with Trousseau syndrome at Toyota Kosei Hospital

The clinical features of 40 patients with Trousseau syndrome at Toyota Kosei Hospital

Two cases of the Trousseau syndrome associated with embolism of unknown origin

Two cases of the Trousseau syndrome associated with embolism of unknown origin

Trousseau syndrome: Carcinoma-associated deep venous thrombosis

Trousseau syndrome: Carcinoma-associated deep venous thrombosis

Rare Presentation of Pancreatic Cancer: A Case Report

Introduction: Hypercoagulable state may be an important first presentation in malignancies especially pancreatic cancer. The trousseau syndrome is caused by venous thrombosis, non-bacterial thrombotic endocarditis and arterial thrombosis. We describe a patient who had the cerebral infarction as the initial manifestation of pancreatic cancer and we discuss that full work up for every patient with atypical stroke should be done. Case Presentation: We report a 67-year-old man who developed multiple cerebral infarctions as the initial manifestation of pancreatic cancer. Cancer antigen 19-9 (CA 19-9) was 52,065 U/mL (Normal value: 0 - 33 U/mL), computerized tomography (CT) scan of the abdomen showed multiple hypodensities in both lobes of the liver and Heterogeneous hypodensity was seen in the pancreas that was highly suggestive of pancreas adenocarcinoma and was confirmed with the biopsy. Conclusions: In the case of multiple brain infarctions in both anterior and posterior circulation, without evidence of common cause, trousseau syndrome and hypercoagulability state should be considered.

P2.06-003 Retrospective Study of Cerebral Thromboembolism Occurring before and after Detection of Lung Cancer (Trousseau Syndrome)

Armand Trousseau reported the concept of blood coagulation disorders accompanying malignancies in 1865. Currently, Trousseau syndrome is also defined as cerebral infarction due to malignant tumors. Among cerebral infarction patients with cancer, lung cancer (LC) and prostatic cancer are reported to be relatively likely to develop Trousseau syndrome. When it occurs, treatment for cancer is difficult, and prognosis is poor. We conducted a retrospective study of LC patients before and after the onset of cerebral infarction, respectively.

The serial D-dimer measurements predicts the prognoses of Trousseau’s syndrome patients

Background: Acute multiple embolic infarction (AMEI) due to cancer is known as Trousseau’s syndrome (TS). We previously reported that D-dimer level (DD) ≥2.0 μg/mL at onset of AMEI and the elevation of DD under anticoagulation therapy was a useful diagnostic marker of TS.

Correlation between mucin tumor markers and hypercoagulability in Trousseau's syndrome associated with stroke

Correlation between mucin tumor markers and hypercoagulability in Trousseau's syndrome associated with stroke

EGFR mutation and ALK fusion oncogene decrease stroke risk in patient with trousseau syndrome due to lung adenocarcinoma

EGFR mutation and ALK fusion oncogene decrease stroke risk in patient with trousseau syndrome due to lung adenocarcinoma

Coagulation and fibrinolysis in gastric cancer.

Coagulation is a highly conserved process occurring after an injury to a blood vessel and resulting in hemostasis. In the thrombus microenvironment, finely orchestrated events restore vessel integrity through platelet activation, adhesion, and aggregation (primary hemostasis), followed by the coagulation cascades, thrombin generation, and fibrin clot deposition (secondary hemostasis). Several studies on cancer have provided insight into dramatic changes to coagulation-related events (i.e., fibrin clot deposition, fibrinolysis) during tumor pathogenesis, progression, and metastasis, in addition to a tumor-driven systemic activation of hemostasis and thrombosis (Trousseau's syndrome). Diverse molecular and cellular effectors participate in the cross talk between hemostasis and tumors. Here, we focus on some aspects of the interconnection between cancer biology and hemostatic components, with particular attention to some key coagulation-related proteins (e.g., tissue factor, thrombin, fibrinogen, and D-dimers) in the particular case of gastric cancer (GC). Recent advances in deciphering the complex molecular link between GC and the coagulation system are described, showing their important roles in better management of patients affected by GC.

Marantic endocarditis and paraneoplastic pulmonary embolism

Cancer is frequently associated with a hypercoagulable state. Almost 15% of patients with cancer will suffer a thromboembolic event during their clinical course. The aetiology of this hypercoagulable state is...

Bilateral cerebral embolism as a characteristic feature of patients with Trousseau syndrome

Trousseau syndrome is defined as a variant of intravascular thromboembolism that is induced by cancer. It may manifest itself as cerebral embolisms in some cases; however, when the cancer is not diagnosed, this identification may be difficult. Therefore, cerebral embolisms are often treated without identifying the cancer, which can worsen a patient’s condition. The purpose of this study was to determine the differences in clinical features between cerebral embolisms induced by cancer (Trousseau syndrome) and those that are due to other causes, such as cardiogenic embolisms and artery-to-artery stroke. A total of 83 patients, admitted to our hospital between April 2005 and March 2013 with cerebral embolisms, were included in this study. Of these, 9 (10.8%) were diagnosed with Trousseau syndrome, 63 (75.9%) had cardiogenic embolisms and 11 (13.2%) had artery-to-artery embolisms. Patients with embolic stroke of undetermined source (ESUS) were excluded from the study. We retrospectively investigated the localization of the infarctions, cancer type, and pathology, and the levels of primary fibrin/fibrinogen degradation products (FDP). From the nine patients with Trousseau syndrome, eight had adenocarcinomas and all had elevated initial FDP. Bilateral cerebral embolisms were significantly more common in Trousseau syndrome patients than cardiogenic embolisms (P=0.00026) and artery-to-artery embolisms (P=0.0016). All of them contained microembolisms as observed by magnetic resonance imaging (MRI). This study suggests that bilateral infarctions presenting microembolisms are important features of cerebral embolism attributed to Trousseau syndrome.

MP87-07 THE BIOLOGICAL RAMIFICATIONS OF PROSTATE CANCER ASSOCIATED CELL FREE DNA: EFFECT ON PLATELET FUNCTION AND DISEASE PROGRESSION

You have accessJournal of UrologyProstate Cancer: Basic Research & Pathophysiology III1 Apr 2017MP87-07 THE BIOLOGICAL RAMIFICATIONS OF PROSTATE CANCER ASSOCIATED CELL FREE DNA: EFFECT ON PLATELET FUNCTION AND DISEASE PROGRESSION Mackenzie Adams, James Henderson, Mathew Lee, Todd Morgan, Ganesh Palapattu, and Alexander Zaslavsky Mackenzie AdamsMackenzie Adams More articles by this author , James HendersonJames Henderson More articles by this author , Mathew LeeMathew Lee More articles by this author , Todd MorganTodd Morgan More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , and Alexander ZaslavskyAlexander Zaslavsky More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2711AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The risk of developing venous thromboembolic events (VTE) is increased up to 4-fold in in men diagnosed with metastatic prostate cancer (PCa). While the precise reasons for this are unknown previous work has established the capacity of platelets (clot initiators) to absorb factors from the bloodstream that may alter platelet functions. Notably, one such factor, cell free DNA (cfDNA) has been shown to strongly correlate with disease severity and outcome. In this study, we sought to examine the effects of cfDNA from men with aggressive PCa on platelets in the context of clot formation and disease progression. METHODS Platelets were isolated from venous blood of 10 men with metastatic castration resistant prostate cancer (mCRPC). Platelet aggregation in response to agonists (i.e. thrombin and collagen) was established using platelet aggregometer. Platelet ability to bind to cancer cells (in vitro) was determined using flow cytometry. Platelet effect on prostate tumor growth in vivo was assessed using human platelet transfusions into 3 different PCa mouse models (intracardiac, subcutaneous, and orthotopic) in combination with standard bioluminescence techniques. RESULTS We assessed the effects of tumor associated nucleic acids on circulating platelets. We found that PCa derived cfDNA - loaded platelets were more reactive to agonists (thrombin and collagen), vs. unloaded platelets, making them more susceptible to spontaneous clot formation. We established that platelets from men with mCRPC (10 men) were significantly (p<0.001) more adherent to cancer cells in vitro as compared to platelets from healthy controls. Addition of nucleic acids (i.e. DNA) to healthy donor platelets in vitro converted them to be more thrombogenic and similar to platelets from men with mCRPC. Finally, we observed that platelets from men with mCRPC strongly induced cell proliferation and tumor growth in vivo (p<0.005), as compared to platelets from healthy controls. CONCLUSIONS High levels of cancer associated cfDNA have been previously demonstrated to correlate with poor prognosis and increased risk of VTE in men with PCa. Intriguingly, we found that PCa associated cfDNA modulates platelet behavior, revealing, for the first time, a potential molecular basis for Trousseau syndrome in PCa. Further, our findings also shed new light on how cfDNA may alter cancer growth via modulating platelets in the tumor microenvironment. Taken together, our study provides novel insights into the possible biological consequences of cfDNA seen in the advanced cancer state. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1168 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Mackenzie Adams More articles by this author James Henderson More articles by this author Mathew Lee More articles by this author Todd Morgan More articles by this author Ganesh Palapattu More articles by this author Alexander Zaslavsky More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

O2-2-5 - Thrombectomy for Trousseau syndrome- related acute cerebral vessel occlusion: Histological examination

O2-2-5 - Thrombectomy for Trousseau syndrome- related acute cerebral vessel occlusion: Histological examination