Introduction Demographics Causes Clinical features Complications Diagnosis Differential diagnoses Treatment Outcome
Trousseau syndrome is an acquired blood clotting disorder that results in migratory thrombophlebitis (inflammation of a vein due to a blood clot) in association with an often undiagnosed malignancy.
Trousseau syndrome has many synonyms including ‘migratory superficial thrombophlebitis’, 'hypercoagulability syndrome associated with cancer', and ‘tumour-associated thromboembolism’.
Trousseau syndrome develops in the setting of either an undiagnosed malignancy or at the same time as the cancer diagnosis.
Pancreatic cancer appears to be associated with the highest risk of Trousseau syndrome, but other tumours, particularly mucin-producing adenocarcinomas (cancers that develop in the lining or inner surface of an organ) such as lung and gastric can also cause the syndrome.
Many mechanisms for blood clotting in Trousseau syndrome have been proposed and there is probably no single pathogenic pathway. It is likely the tumour cells release products into the bloodstream such as mucin, tissue factor, and cysteine protease, resulting in thrombin activation and fibrin deposition. Oncogene activation and tissue hypoxia may also be involved.
Superficial thrombophlebitis may involve either the arterial or venous system. Lesions appear as inflamed, reddened lines or lumps in the fat under the skin. They may occur on the trunk or extremities.
The patient may present with signs of embolism, such as blue toe syndrome.
A patient with unexplained acute thromboembolism may be investigated with abdominal/pelvic CT scan and mammography for an occult malignancy.
Trousseau syndrome is the second commonest cause of death in cancer patients. It can progress rapidly, resulting in death. However if the underlying cancer is cured, the thromboembolism resolves.
