Sierra-Montenegro E, Sierra-Luzuriaga G, Calle-Loffredo D, Rodríguez-Quinde M

Language: Spanish
References: 23
Page: 242-245
PDF size: 136.36 Kb.

ABSTRACT

Background: The Trousseau syndrome, first described in 1865, is the relationship of venous thromboembolism and cancer. The objective is to inform a case with rectal cancer and this Trousseau syndrome.
Clinical case: Female 40 years old, went to the Coloproctology service for painless bleeding, we solicited requested diagnostic tests, report of computed tomography was tumor of 5 per 6 cm up to 5 cm from the anal margin, ultra-low anterior resection with colonic reservoir and loop ileostomy surgery was performed, report of pathology semidiferenciate adenocarcinoma of rectum and we established as T3N0M0. Within 72 hours of hers postoperative sudden hypotension, painful abdominal distention, we made a surgery again finding necrosis of the colon from the splenic angle till the colonic reservoir with thrombi in the left colic artery, ischemic signs of bilateral fallopian tubes, ovaries, uterus, pelvic floor and the small intestine, 40 cm before ileostomy and ileon. Left hemicolectomy and colostomy was made. She was taken to intensive care in where they continue administration of heparin; it dies within 5 days after because of multiorganic failure.
Conclusions: The mechanism for this syndrome was unknown but there are several hypotheses, suggested that hematological cancers are what they are at increased risk of deep vein thrombosis. Pancreatic cancer is the most common presentation with this syndrome in 50% of cases. We suggested continuing with the standards of prevention of thromboembolism.

REFERENCES

1. Kakkar A. Thromboprophylaxis in the Cancer Patient. Venous Tromboembolism 2005;4:151-157.

2. Bouillard JB, Bouillard S. De l`Obliteration des veines et de son influence sur la formation des hydropisies partielles: consideration sur la hydropisies passive et general. Arch Gen Med 1823;1:188-204.

3. Varki A. Trousseau`s syndrome: multiple definitions and multiple mechanisms. Blood 2007:110:1723-1729.

4. Rickles FR. Mechanisms of Cancer-Induced Thrombosis in Cancer. Pathophysiol Haemost Thromb 2006;35:103-110.

5. Rak J, Milson C, May L, Klement P, Yu J. Tissue factor in cancer and angiogenesis: the molecular link between genetic tumor progression, tumor neovascularization, and cancer coagulopathy. Semin Thromb Hemost 2006;32:54-70.

6. Donati MB, Gambacorti-Passerini C, Casali B, Falanga A, Vannotti P, Fossati G, et al. Cancer Procoagulant in Human Tumor Cells: Evidence from Melanoma Patients. Cancer Res 1986;46:6471-6474.

7. Grignani G, Falanga A, Pacchiarini L, Alessio MG, Zucchella M, Fratino P, et al. Human breast and colon carcinomas express cysteine proteinase activities with pro-aggregating and pro-coagulant properties. Int J Cancer 1988;42:554-557.

8. Kaźmierczak M, Lewandowski K, Wojtukiewicz MZ, Turowiecka Z, Kołacz E, Łoiko A, et al. Cancer procoagulant in patients with adenocarcinomas. Blood Coagul Fibrinolysis 2005;16:543-547.

9. Carraway KL, Fregien N, Carraway CAC, Carraway KL III. Tumor sialomucin complexes as tumor antigens and modulators of cellular interactions and proliferation. J Cell Sci 1992;103:299-307.

10. Kim YJ, Borsig L, Han HL, Varki NM, Varki A. Distinct Selectin Ligands on Colon Carcinoma Mucins Can Mediate Pathological Interactions among Platelets, Leukocytes, and Endothelium. Am J Pathol 1999;155:461-472.

11. Petralia GA, Lemoine NR, Kakkar AK. Mechanisms of Disease: the impact of antithrombotic therapy in cancer patients. Nat Clin Pract Oncol 2005;2:356-363.

12. Colman RW. Are hemostasis and thrombosis two sides of the same coin? J Exp Med 2006;203:493-495.

13. Hoffman R, Haim N, Brenner B. Cancer and thrombosis revisited. Blood Rev 2001;15:61-67.

14. Oleksowicz L, Bhagwati N, DeLeon-Fernandez M. Deficient Activity of von Willebrand´s Factor-cleaving Protease in Patients with Disseminated Malignancies. Cancer Res 1999;59:2244-2250.

15. Levitan N, Dowlati A, Remick SC, Tahsildar HI, Sivinski LD, Beyth R, et al. Rates of Initial and Recurrent Thromboembolic Disease Among Patients with Malignancy Versus Those without Malignancy: Risk Analysis Using Medicare Claims Data. Medicine 1999;78:285- 291.

16. Pinzon R, Drewinko B, Trujillo JM, Guinee V, Giacco G. Pancreatic carcinoma and Trousseau`s syndrome: experience at a large cancer center. J Clin Oncol 1986;4:509-514.

17. Rak J, Klement G. Impact of Oncogenes and Tumor Suppressor Genes on Deregulation of Hemostasis and Angiogenesis in Cancer. Cancer Metastasis Rev 2000;19:93-96.

18. Contrino J, Hair G, Kreutzer DL, Rickles FR. In situ detection of tissue factor in vascular endothelial cells: Correlation with the malignant phenotype of human breast disease. Nat Med 1996;2:209- 215.

19. Bell Wr, Starksen NF, Tong S, Porterfield JK. Troisseau`s syndrome. Devastating coagulopathy in the absence of heparin. Am J Med 1985;79:423-430.

20. Van Deerlin WM, Tollefsen DM. Molecular interactions between heparin cofactor II and thrombin. Semin Thromb Hemost 1992;18:341-346.

21. Neese LL, Wolfe CA, Church FC. Contribution of Basic Residues of the D and H Helices in Heparin Binding to Protein C Inhibitor. Arch Biochem Biophys 1998;355:101-108.

22. Castelli R, Porro F, Tarsia P. The heparins and cancer: review of clinical trials and biological properties. Vasc Med 2004;9:205-213.

23. Batsis J, Morgenthaler T. Trousseau syndrome and the unknown cancer: use of positron emission tomographic imaging in a patient with a paraneoplastic syndrome. Myo Clin Pro 2005;80:537-540.