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Ann Hematol Oncol.2017; 4(4): 1144.
Trousseau’s Syndrome in Metastatic Vulval Carcinoma
O’Shea N* and Kiely F
Department of Palliative Medicine, Marymount University Hospital & Hospice, Ireland
*Corresponding author: O’Shea N, Department of Palliative Medicine, Marymount University Hospital & Hospice, Cork, Ireland
Received: February 28, 2017; Accepted: March 16, 2017; Published: March 24, 2017
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Trousseau’s Syndrome initially described patients presenting with spontaneous or recurrent episodes of venous thrombosis and arterial emboli, with an occult neoplasm [1]. Recently, the term has been applied to patients with a known malignancy. The pathogenesis of Trousseau’s Syndrome is complex and multi-variable, including intravascular hypercoagulable tumour material [2,3], tumourproducing cytokines [4,5] and external factors.
A 60 year old lady with a diagnosis of metastatic vulval cancer was diagnosed with a right leg deep vein thrombosis.
Doppler ultrasound venogram revealed thrombus in the right common femoral, superficial femoral and popliteal veins. Despite anticoagulation with Tinzaparin, she subsequently presented with left upper limb weakness, dysarthria and right facial droop.
MRI brain revealed an acute infarct in posterior right frontal lobe. There were additional smaller foci of infarction in the parietooccipital regions bilaterally. Therefore, the differential diagnosis of a patient with cancer presenting with neurological symptoms needs to include Trousseau’s Syndrome.
Figure 1: Diffusion restriction in the right frontal lobe, indicating an acute
infarct.
Figure 2: Multifocal signal abnormality in the periventricular and deep
cerebral white matter bilaterally.
References
- Trousseau A. Plegasia alba dolens. Lectures on clinical medicine, delivered at the Hotel-Dieu. Paris. 1865; 5: 281-332.
- Kenney WE. The association of carcinoma in the body and tail of the pancreas with multiple venous thrombi. Surgery 1943; 14: 600-609.
- McKay DG, Wahle GH Jr. Disseminated thrombosis in colon cancer. Cancer. 1955; 8: 970-978.
- Pineo GF, Brain MC, Gallus AS, Hirsh J, Hatton MW, Regoeczi E. Tumours mucus production and hypercoagulability. Ann N Y Acad Sci. 1974; 230: 262- 270.
- Rak J, Milsom C, May L, Klement P, Yu J. Tissue factor in cancer and angiogenesis: the molecular link between genetic tumour progression, tumour neovascularisation, and cancer coagulopathy. Semin Thromb Hemost. 2006; 32: 54-70.
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