Sasaki Ryosuke, Ohya Yuki, Hayashida Shintaro, Maeda Yuto, Murahashi Shuei, Kumamoto Sayahito, Tsuji Akira, Shibata Hidekatsu, Kuramoto Kunitaka, Hayashi Hironori, Kuriwaki Kazumi, Iizaka Masayoshi, Nakahara Osamu, Inomata Yukihiro
Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
Department of Neurology, Kumamoto Rosai Hospital, 1670 Takehara-machi, Yatsushiro, Kumamoto, 866-8533, Japan.
Surg Case Rep. 2020 Apr 19;6(1):75. doi: 10.1186/s40792-020-00835-8.
Trousseau's syndrome is a cancer-associated thrombosis. Trousseau's syndrome with cholangiocarcinoma is a rare condition with poor prognosis.
A 59-year-old female was admitted to our hospital with abdominal pain, headache, and nausea. Abdominal enhanced computed tomography revealed liver tumor, splenic infarction, and bilateral renal infarction. Multiple acute cerebral infarctions were also detected by magnetic resonance imaging. Her preoperative serum levels of carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were > 120,000 U/mL and 589.6 ng/mL, respectively, which were extremely high. Histopathology after right hepatectomy revealed moderately differentiated adenocarcinoma consistent with intrahepatic cholangiocarcinoma. Her serum levels of CA19-9 were trending down to 9029.2 and 2659.8 U/mL at 1 and 3 weeks after surgery, respectively. However, at 7 weeks after surgery, her CA19-9 levels increased in the presence of positive imaging findings in the remnant liver, hilar lymph nodes, and peritoneal cavity. The initiation of combination chemotherapy including gemcitabine and cisplatin had a significant effect. The patient was doing well at 6 months after the surgery.
This rare case of Trousseau's syndrome due to cholangiocarcinoma suggests that extremely high CA19-9 levels might be a pathogenic factor of this syndrome.
特鲁索综合征是一种与癌症相关的血栓形成。伴有胆管癌的特鲁索综合征是一种罕见疾病，预后较差。
一名59岁女性因腹痛、头痛和恶心入住我院。腹部增强计算机断层扫描显示肝肿瘤、脾梗死和双侧肾梗死。磁共振成像还检测到多发性急性脑梗死。她术前血清糖类抗原19-9（CA19-9）和癌胚抗原（CEA）水平分别>120,000 U/mL和589.6 ng/mL，极高。右肝切除术后的组织病理学显示为中分化腺癌，符合肝内胆管癌。术后1周和3周时，她的CA19-9血清水平分别降至9029.2和2659.8 U/mL。然而，术后7周时，在残余肝脏、肝门淋巴结和腹腔存在阳性影像学表现的情况下，她的CA19-9水平升高。启动包括吉西他滨和顺铂的联合化疗产生了显著效果。术后6个月时患者情况良好。
这例罕见的由胆管癌引起的特鲁索综合征表明，极高的CA19-9水平可能是该综合征的致病因素。
