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Jun Fujinami
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EP1.01 - Advanced NSCLC (ID 150)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Advanced NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.01-73 - Trousseau's Syndrome Associated with Pulmonary Pleomorphic Carcinoma Showing Aggressive Features: A Case Report (Now Available) (ID 3122)
08:00 - 18:00 | Author(s): Jun Fujinami
- Abstract
Background
Trousseau's syndrome is characterized as an unexpected cancer-related thrombotic event, such as a cerebral infarction or a deep vein thrombosis/pulmonary embolism. The histology of most reported cases of lung cancer with Trousseau's syndrome involves adenocarcinoma. We describe the first reported case of Trousseau's syndrome with pulmonary pleomorphic carcinoma and aggressive features.
Method
A 74-year-old man, a current heavy smoker (38 pack-years), presented with a well-circumscribed peripheral mass (diameter: 38 mm) in the lower lobe of the left lung. A fluorine-18-fluorodeoxyglucose (FDG) positron-emission tomography scan showed a strong accumulation of FDG in the mass. Serum carcinoembryonic antigen (CEA) and D-dimer levels were 16.0 ng/mL and 0.6 µg/mL, respectively. A left lower lobectomy with systemic mediastinal lymph node dissection revealed the tumor was pleomorphic carcinoma with extensive lymph node involvement and was graded as pT3N2M0, pStage IIIB (pm1, pl1, ly1, v1, br+). The tumor mainly comprised giant cells with high-grade pleomorphism, admixed with a solid adenocarcinoma component and papillary growth pattern. The adenocarcinoma component was positive for periodic acid-Schiff (PAS) stain and resistant to diastase, suggesting mucin production. Moreover, most of the tumor cells were strongly positive for tissue factor (clone TF (H-9)).
Result
Three months postoperatively, diffuse infiltration rapidly appeared in plain chest radiographs of the left lung, which was identified as lymphangitic carcinomatosis via bronchoscopy. Prior to treatment for cancer recurrence, the patient suddenly presented with dysarthria and left hemiplegia. Magnetic resonance imaging revealed acute ischemic stroke in the right hemisphere accompanied with subacute small infarcts in the left hemisphere and bilateral cerebellum. Magnetic resonance angiography revealed a right middle cerebral artery M2 segment occlusion. An echography and a chest CT showed no evidence of atherosclerotic thrombus or cardiac thrombus in the left atrium or in the stump of the resected pulmonary vein. Plasma D-dimer level was elevated at 17.6 µg/mL, as were the CEA and carbohydrate antigen 125 (CA125) levels (73.4 ng/mL and 331 U/mL), respectively. He underwent mechanical thrombectomy with a stent retriever, and partial recanalization was achieved. The pathology of the retrieved thrombus showed that almost all parts consisted of fibrin without red blood cells. These findings and pathological findings of the primary lung cancer suggested Trousseau’s syndrome as the etiology of the cerebral infarction.
Conclusion
A hypercoagulable state, due to aggressive recurrence of pulmonary pleomorphic carcinoma accompanying with cancer cell production of mucin and tissue factor, may be a potential mechanism for cancer-related thrombosis.
