Primary diffuse large B-cell lymphoma of the cranial vault with Trousseau syndrome: a case report

Background It is extremely rare for primary non-Hodgkin’s lymphomas to occur singly in the cranial vault. One case diagnosed as primary diffuse large B-cell lymphoma is reported, initially misdiagnosed as metastatic skull tumor, complicated with Trousseau syndrome. Case description The patient was a 60-year-old Japanese woman with no particular previous medical history. In a head computed tomography examination for vertigo, bone destructive skull tumor covering the right frontal, parietal, and temporal bones was incidentally discovered. As positron emission tomography indicated an abnormal accumulation in the large intestine and multiple cerebral infarctions suspicious of Trousseau syndrome were observed on magnetic resonance images, a metastatic skull tumor due to colorectal cancer was first considered. However, various tumor markers were negative, and colonoscopic biopsy indicated no colorectal abnormality. After pathological examination of the resected tumor, it was diagnosed as diffuse large B-cell lymphoma. The tumor affected muscles and skin but did not develop in the brain or the dura mater. As further general examination revealed no other abnormalities, we considered that it was primary diffuse large B-cell lymphoma in the cranial vault associated with Trousseau syndrome. Treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and high-dose methotrexate reduced the residual lesion; coagulation abnormalities, which are frequently associated with Trousseau syndrome, also improved. Conclusions Skull tumors can result from a variety of malignancies, and their diagnosis may be complicated with Trousseau syndrome. However, even in cases of a single lesion in the cranial vault without invasion of the central nervous system, diffuse large B-cell lymphoma should be considered as a differential diagnosis.

Trousseau Syndrome Secondary to Carcinoma Gall Bladder: Case Report

Trousseau syndrome is the phenomenon in which an occult visceral malignancy is the underlying cause of an unexpected thrombotic event. Trousseau syndrome has a well-established association with advanced primary pancreatic and pulmonary malignancies and others like prostate, stomach, colon, and hematologic malignancies can be associated. Here we report a case from whose initial presentation we thought that it was stroke, but later she developed DVT in both legs and after investigation it was suspicious of carcinoma gall bladder. Keywords: DVT- deep vein thrombosis, VTE- venous thromboembolism, trousseau syndrome.

Multiple cerebral infarction linked to underlying cancer: a review of Trousseau syndrome-related cerebral infarction

Trousseau syndrome is a cancer-associated hypercoagulative state leading to venous or arterial thromboembolic events. Cerebral infarction is the most common result of arterial embolism and the pathogenesis is complicated, mainly associated with hypercoagulation and non-bacterial thrombotic endocarditis. On magnetic resonance imaging, multiple lesions are dispersed in more than two territories of the brain, often simultaneously involving the bilateral anterior and posterior circulation. Elevated plasma levels of D-dimer and fibrinogen degradation products may be seen in these patients. There are high rates of short-term recurrence of stroke and sudden death, highlighting the need for early recognition and appropriate treatment of Trousseau syndrome-associated cerebral infarction.

Trousseau Syndrome in a patient on Direct Oral Anticoagulant use: A Case Report

Background: The Three Territory Sign (TTS) is a radiologic marker of ischemic stroke associated with malignant neoplastic diseases (Trousseau Syndrome) and corresponds to a rare stroke etiology. Case Report: Female, 62-year-old patient, with comorbidities of smoking, hypertension and diabetes, presented with a sudden faciobrachial-predominant left hemiparesis settled in the day before the admission. Diagnosed with a metastatic rectal adenocarcinoma seven months before, she underwent a rectosigmoidectomy three months ago and developed deep vein thrombosis, starting anticoagulant therapy with rivaroxaban 20mg daily. A Magnetic Resonance Imaging (MRI) revealed several lesions with restricted diffusion in multiple vascular territories, bilaterally, corresponding to ischemic stroke. Etiologic investigation did not detect signs of cardioembolism, nor significant vessel stenosis or unstable atherosclerotic plaques. In admission, she had a D-dimer level of 11,43μg (0- 0,5μg/mL). Conclusion: The evidence of TTS is about six times more frequent in stroke related to malignancies compared to cardioembolic etiology. The D-dimer is a marker of malignancies in cryptogenic stroke, elevated in 75% of cases. The most common associated neoplasms are pulmonary (40%) and gastrointestinal (33,3%). In the MRI, the lesions can be isolated or gathered, generally small and peripheral. There is no evidence regarding the ideal preventive therapy. It is necessary to reinforce the importance of investigating malignancies in patients presenting with cryptogenic stroke and TTS, a syndrome that is still poorly recognized.