Trousseau sign of malignancy

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The Trousseau sign of malignancy or Trousseau's Syndrome is a medical sign found in certain cancers that is associated with venous thrombosis[1] and hypercoagulability. It is characterized by successive crops of tender nodules in affected veins.[2] It is also referred to as Trousseau syndrome[3] and is distinct from the Trousseau sign of latent tetany.

The pathological phenomenon of clots forming, resolving and then appearing again elsewhere in the body has also been named thrombophlebitis migrans or migratory thrombophlebitis, as opposed to plain thrombophlebitis in one location.

History[edit]

Armand Trousseau first described this finding in the 1860s; he later found the same sign in himself, was subsequently diagnosed with pancreatic cancer and died soon thereafter.[4] Dr. Trousseau presciently attributed thromboembolism in malignancy to changes in blood composition rather than local inflammatory or mechanical forces. By correlating clinical observation with surgical and autopsy findings, Dr. Trousseau recognized that a localized cancer could induce a generalized hypercoagulable state in which thrombosis could occur elsewhere in the body, such as in extremities with visceral malignancy. Dr. Trousseau described several cases in which recurrent thrombosis was the presenting feature of visceral cancer, and his confidence in the utility of this connection led him to say, "So great, in my opinion, is the semiotic value of phlegmasia in the cancerous cachexia, that I regard this phlegmasia as a sign of the cancerous diathesis as certain as sanguinolent effusion into the serous cavities."

The discovery later allowed Dr. Trousseau to diagnose himself. At the age of 66, he noticed phlebitis in his left upper arm. He diagnosed a visceral malignancy, and died of pancreatic cancer only months later.

Pathophysiology[edit]

Some malignancies, especially gliomas (25%), as well as adenocarcinomas of the pancreas and lung, are associated with hypercoagulability (the tendency to form blood clots) for reasons that are incompletely understood, but may be related to factors secreted by the tumors, in particular a circulating pool of cell-derived tissue factor-containing microvesicles.[5] Some adenocarcinomas secrete mucin that can interact with selectin found on platelets, thereby causing small clots to form [6]

In patients with malignancy-associated hypercoagulable states, the blood may spontaneously form clots in the portal vessels, the deep veins of the extremities (such as the leg), or the superficial veins anywhere on the body. These clots present as visibly swollen blood vessels (vasculitis), especially the veins, or as intermittent pain in the affected areas.

References[edit]

  1. ^ "Trousseau sign" at Dorland's Medical Dictionary
  2. ^ Trousseau's sign of visceral malignancy in GPnotebook, retrieved November 2012
  3. ^ "Trousseau syndrome" at Dorland's Medical Dictionary
  4. ^ Samuels MA, King ME, Balis U (October 2002). "Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 31-2002. A 61-year-old man with headache and multiple infarcts". N. Engl. J. Med. 347 (15): 1187–94. doi:10.1056/NEJMcpc020117. PMID 12374880. 
  5. ^ Del Conde I, Bharwani LD, Dietzen DJ, Pendurthi U, Thiagarajan P, López JA.(2007) Microvesicle-associated tissue factor and Trousseau's syndrome. J Thromb Haemost 5:70-4
  6. ^ Wahrenbrock M, Borsig L, Le D, Varki N, Varki A. (2003) "Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas." J Clin Invest 112: 853-862.