Much More than Trousseau Syndrome. The Broad Spectrum of the Pancreatic Paraneoplastic Syndromes

Abstract

When 150 years ago Armand Trousseau proposed that some thrombotic events might be the first sign of concealed visceral malignancies, these findings seemed to be just of anecdotal interest. Since then, however, we have learned that adenocarcinomas, including pancreatic cancers could be associated with a wide spectrum of paraneoplastic syndromes. They may precede the detection of the tumor, may occur simultaneously or may develop during its progression. Due to various hematologic, endocrine, cutaneous, articular, neuromuscular, renal or even psychiatric syndromes, their correct interpretation is intriguing, and because their early signs are not necessarily recognized first by oncologists, the paraneoplastic syndromes pose a diagnostic challenge. Unfortunately, we cannot generalize about their mechanisms, because the molecular backgrounds are far-reaching. In most of the cases, the pancreatic cancer cells release various factors into the bloodstream triggering the coagulation cascade. These patients frequently present with venous thromboembolism, and sometimes they are resistant to anticoagulation. The simultaneous thrombotic and bleeding evens do reflect the abnormal hemostasis. In other instances autoantibodies are formed against cutaneous, renal, neuromuscular or nervous tissues, but the mechanism of some syndromes remains unclear. Clinicians should be aware that pancreatic carcinoma may be associated with not just the Trousseau-syndrome.

The relationship between pancreatic cancer and hypercoagulability: a comprehensive review on epidemiological and biological issues

“…In pancreatic cancer, significantly elevated plasma levels of fibrinogen, factor (F)VIII and D-dimer have been observed, whereas diminished levels of protein C and antithrombin III have been reported, although levels might change during tumour progression. 28 , 29 More importantly, pancreatic cancer cells directly produce a number of factors, or influence a number of activities, that promote coagulation (Fig. 1 ).…”

<p>Atractylon induces apoptosis and suppresses metastasis in hepatic cancer cells and inhibits growth in vivo</p>

“…The occurrence and development of liver cancer are related to many factors. In the developed countries, such as Europe and United States, obesity, adult diabetes and internal environmental disorders are the main stimulating factors of liver cancer, while in the developing countries, hepatitis viruses (HBV and HCV), long-term intake of ethanol, and aflatoxin-contaminated food play an important role in the formation of liver cancer 4,5. Surgical resection is the preferred option for early-stage liver cancer patients and confers 5-year survival rates of 70%.…”

Suitability of Thrombolysis for Patients With Acute Ischemic Stroke Complicated With Trousseau Syndrome

“…Since Armand Trousseau's proposal 150 years ago that thrombotic events may be the first sign of concealed visceral malignancies (Zalatnai et al, 2018), the relationship between cancer and vascular infarction events has been investigated. Although the cause of TS remains unclear, recent studies have shown that the role of the tumor itself, the effect of hypercoagulability, and the side effects of tumor-related treatment may be the causes of the disease.…”