Abstract
Here we report a rare case of Trousseau’s syndrome in a patient with gastric cancer with multiple intramural metastases and metastasis to the small intestine. A 70 year-old male complaining of appetite loss and weight loss of 7 kg within 3 months was admitted to hospital. Esophagogastroduodenal endoscopy revealed an advanced gastric cancer at the pylorus almost occluding the outlet of the stomach, and multiple ulcerative lesions throughout the stomach. A biopsy showed poorly differentiated adenocarcinoma. The patient underwent total gastrectomy. During surgery, part of the distal ileum was found to be abnormally firm and approximately 1 m of the ileum with the cecum colon was resected. Pathologic examination confirmed poorly differentiated adenocarcinoma at the pylorus and multiple intramural metastases in most other areas of the stomach. Lymph node metastases were confirmed in 12 out of 40 harvested regional lymph nodes including one positive paraaortic lymph node. The resected ileum contained multiple tumors with ulceration. Massive lymphatic invasion in the stomach and the small intestine was observed, which strongly suggested lymphatic spread of the gastric cancer. The patient was discharged on post-operative day 21; however, 2 months after surgery, he developed multiple cerebral thromboembolisms and died 2 weeks later.
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Acknowledgments
We are grateful to Dr. Shinichiro Nakamura for the diagnosis of Trousseau’s syndrome. We also would like to thank Dr. Athanasios Tsiatis for helpful discussion.
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Conflict of Interest: The authors declare that they have no conflict of interest.
Human/Animal Rights:All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional and National) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed Consent: Informed consent was obtained from all patients for being included in the study.
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Kamiyama, H., Ichikawa, R., Arima, S. et al. Gastric cancer with multiple intramural metastases and metastasis to the small intestine which eventually developed Trousseau’s syndrome: report of a case . Clin J Gastroenterol 7, 117–122 (2014). https://doi.org/10.1007/s12328-014-0453-y
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DOI: https://doi.org/10.1007/s12328-014-0453-y