Trousseau sign of malignancy

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The Trousseau sign of malignancy or Trousseau's Syndrome is a medical sign involving episodes of vessel
inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time
(thrombophlebitis migrans or migratory thrombophlebitis). The location of the clot is tender and the clot can
be felt as a nodule under the skin.[1] Trousseau's syndrome is a rare variant of venous thromboembolism (VTE)
that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the
chest wall and arms. This syndrome is particularly associated with pancreatic and lung cancer.[2]

Trousseau's Syndrome can be an early sign of gastric or pancreatic cancer,[3] typically appearing months to years
before the tumor would be otherwise detected.[4] Heparin therapy is recommended to prevent future clots.[5] The
Trousseau sign of malignancy should not be confused with the Trousseau sign of latent tetany caused by
hypocalcemia.

History
Armand Trousseau first described this finding in the 1860s; he later found the same sign in himself, was
subsequently diagnosed with gastric cancer and died soon thereafter.[6] 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, 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. 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."
However he was later diagnosed with pancreatic cancer on post mortem examination.

Pathophysiology
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.[7] Some adenocarcinomas secrete mucin that can interact with selectin found on platelets, thereby
causing small clots to form.[8][9]

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 (thrombophlebitis), especially the veins, or as intermittent pain
in the affected areas.

References
1. Trousseau's sign of visceral malignancy (http://www.gp
notebook.co.uk/simplepage.cfm?ID=-1556807643) in
GPnotebook, retrieved November 2012
 2. Caine, Graham (Nov 2002). "The Hypercoagulable
State of Malignancy: Pathogenesis and Current Debate"
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC15503
39). Neoplasia. 4: 465473. PMC 1550339 (https://ww
w.ncbi.nlm.nih.gov/pmc/articles/PMC1550339) .
PMID 12407439 (https://www.ncbi.nlm.nih.gov/pubme
d/12407439). doi:10.1038/sj.neo.7900263 (https://doi.o
rg/10.1038%2Fsj.neo.7900263).
3. Callander, N; S I Rapaport (1993). "Trousseau's
syndrome." (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC1022062). Western Journal of Medicine. 158 (4):
364371. ISSN 0093-0415 (https://www.worldcat.org/i
ssn/0093-0415). PMC 1022062 (https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC1022062) . PMID 8317122
(https://www.ncbi.nlm.nih.gov/pubmed/8317122).
4. "Trousseau sign (https://archive.org/web/20090616022
448/http://www.mercksource.com/pp/us/cns/cns_hl_dor
lands_split.jsp?pg=/ppdocs/us/common/dorlands/dorlan
d/nine/000957879.htm)" at Dorland's Medical
Dictionary
5. Callander, N; S I Rapaport (1993). "Trousseau's
syndrome." (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC1022062). Western Journal of Medicine. 158 (4):
364371. ISSN 0093-0415 (https://www.worldcat.org/i
ssn/0093-0415). PMC 1022062 (https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC1022062) . PMID 8317122
(https://www.ncbi.nlm.nih.gov/pubmed/8317122).
6. Samuels MA, King ME, Balis U (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): 118794. PMID 12374880 (htt
ps://www.ncbi.nlm.nih.gov/pubmed/12374880).
doi:10.1056/NEJMcpc020117 (https://doi.org/10.105
6%2FNEJMcpc020117).
7. Del Conde I, Bharwani LD, Dietzen DJ, Pendurthi U,
Thiagarajan P, Lpez JA (2007). "Microvesicle-
associated tissue factor and Trousseau's syndrome.". J
Thromb Haemost. 5: 704. doi:10.1111/j.1538-
7836.2006.02301.x (https://doi.org/10.1111%2Fj.1538-
7836.2006.02301.x).
8. 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: 853862. doi:10.1172/jci200318882 (http
s://doi.org/10.1172%2Fjci200318882).
9. Varki, Ajit (2007). "Trousseau's syndrome: multiple
definitions and multiple mechanisms" (https://www.ncb
i.nlm.nih.gov/pmc/articles/PMC1976377). Blood. 110
(6): 17231729. ISSN 0006-4971 (https://www.worldca
t.org/issn/0006-4971). PMC 1976377 (https://www.ncb
i.nlm.nih.gov/pmc/articles/PMC1976377) .
PMID 17496204 (https://www.ncbi.nlm.nih.gov/pubme
d/17496204). doi:10.1182/blood-2006-10-053736 (http
s://doi.org/10.1182%2Fblood-2006-10-053736).

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Categories: Medical signs

This page was last edited on 29 March 2017, at 16:32.

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