Photoclinic: Trousseau Syndrome

A morbidly obese 63-year-old woman with type 2 diabetes mellitus and hypertension presented with postmenopausal vaginal bleeding. A uterine biopsy revealed papillary mucinous adenocarcinoma, and biopsy of a breast mass detected during the examination also showed adenocarcinoma. The patient underwent irradiation of the pelvis and breast. Six months later, massive adenopathy developed in the left supraclavicular fossa (A ). Biopsy disclosed metastatic adenocarcinoma, and the area was irradiated. Two months later, the patient complained of severe pain and discoloration of her fingers (B ). She was hospitalized and given anticoagulants. Findings from a vascular evaluation suggested that the gangrene was the result of a hypercoagulable state caused by the mucinous adenocarcinoma. The patient declined further treatment and died 3 weeks later. Rebecca E. Galante, MD, of Hammond, Ind, notes that thrombosis is a common complication of malignancies; it is thought to result from increased activity of the coagulation system. The presentation may be arterial or venous. Cancers associated with deep venous thrombosis include adenocarcinomas of the stomach, lung, pancreas, intestine, and uterus. Trousseau syndrome is a spontaneous, recurrent, superficial migratory thrombophlebitis associated with occult cancers. The syndrome often occurs with mucinous adenocarcinomas, which secrete abnormally glycosylated mucin into the bloodstream. Heparin may be used to prevent recurrent episodes.