Trousseau's syndrome associated with pulmonary pleomorphic carcinoma exhibiting aggressive features: A case report

Okada,Satoru; Miyagawa‑Hayashino,Aya; Fujinami,Jun; Nishimura,Tomoki; Ishikawa,Narumi; Tsunezuka,Hiroaki; Shimomura,Masanori; Shimada,Junichi; Inoue,Masayoshi

doi:10.3892/mco.2019.1947

Trousseau's syndrome associated with pulmonary pleomorphic carcinoma exhibiting aggressive features: A case report

Authors:
- Satoru Okada
- Aya Miyagawa‑Hayashino
- Jun Fujinami
- Tomoki Nishimura
- Narumi Ishikawa
- Hiroaki Tsunezuka
- Masanori Shimomura
- Junichi Shimada
- Masayoshi Inoue
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Affiliations: Division of Thoracic Surgery, Department of Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602‑8566, Japan, Division of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602‑8566, Japan, Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602‑8566, Japan
Published online on: November 11, 2019 https://doi.org/10.3892/mco.2019.1947
Pages: 36-40
Copyright: © Okada et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Trousseau's syndrome is characterized as an unexpected, cancer‑related thrombotic event, such as a cerebral infarction or a deep vein thrombosis/pulmonary embolism. We describe the first reported case of Trousseau's syndrome with pulmonary pleomorphic carcinoma and aggressive features. A 74 year‑old man presenting with a pulmonary mass, which was identified as pleomorphic carcinoma with extensive lymph node involvement, in the left lower lobe, underwent a left lower lobectomy. Immunohistochemical analysis revealed that neoplastic cells exhibited an extensive expression of tissue factors with a mucin‑producing adenocarcinoma component. Three months postoperatively, diffuse infiltration rapidly appeared in the left lung, which was identified as lymphangitic carcinomatosis via bronchoscopy. Prior to treatment for cancer recurrence, the patient presented with a left hemiplegia due to a cerebral infarction via multiple thromboses, with no evidence of atherosclerotic or cardiogenic thrombi. Elevated D‑dimer and carbohydrate antigen 125 levels and the presence of a fibrin thrombus retrieved from the occluded vessel suggested Trousseau's syndrome as the etiology of the brain infarction. A hypercoagulable state associated with the aggressive recurrence of pulmonary pleomorphic carcinoma, accompanied by cancer cell production of mucin and tissue factors may be a potential mechanism for cancer‑related thrombosis.

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