Kitahama Takumi, Otsuka Shimpei, Sugiura Teiichi, Ashida Ryo, Ohgi Katsuhisa, Yamada Mihoko, Uesaka Katsuhiko
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimongakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
Surg Case Rep. 2023 Jan 12;9(1):6. doi: 10.1186/s40792-023-01585-z.
The primary disease of Trousseau's syndrome is often highly advanced cancer, and treatment of the primary disease after cerebral infarction is often difficult. We herein report a case of pancreatic head cancer with Trousseau's syndrome treated with radical resection and anticoagulant therapy.
A 78-year-old man was admitted with dizziness and diagnosed with cerebral infarction. Abdominal contrast-enhanced computed tomography for a thorough checkup indicated borderline resectable pancreatic head cancer. Radical resection after neoadjuvant chemotherapy (NAC; gemcitabine plus nab-paclitaxel) was scheduled. During the second course of NAC, multiple cerebral infarctions recurred, and the patient was diagnosed with Trousseau's syndrome. Continuous intravenous infusion of heparin was started for cerebral infarction. Since it was impossible to continue NAC and there was no worsening of imaging findings, radical resection was planned. Thereafter, he underwent pancreatoduodenectomy with superior mesenteric vein resection. The patient progressed well and was discharged on the 19th day after surgery. He continued subcutaneous injection of heparin at home and is alive without recurrence of cancer or cerebral infarction at more than 21 months after surgery.
Surgical treatment may be an option for pancreatic cancer with Trousseau's syndrome under favorable conditions.
特鲁索综合征的原发性疾病通常是晚期癌症，脑梗死后原发性疾病的治疗往往很困难。我们在此报告一例接受根治性切除和抗凝治疗的伴有特鲁索综合征的胰头癌病例。
一名78岁男性因头晕入院，被诊断为脑梗死。腹部增强计算机断层扫描全面检查显示为可切除边缘的胰头癌。计划在新辅助化疗（NAC；吉西他滨加纳米白蛋白结合型紫杉醇）后进行根治性切除。在NAC的第二个疗程中，多次脑梗死复发，患者被诊断为特鲁索综合征。开始持续静脉输注肝素治疗脑梗死。由于无法继续NAC且影像学检查结果无恶化，计划进行根治性切除。此后，他接受了胰十二指肠切除术并切除了肠系膜上静脉。患者恢复良好，术后第19天出院。他在家继续皮下注射肝素，术后21个月以上仍存活，无癌症复发或脑梗死。
在有利条件下，手术治疗可能是伴有特鲁索综合征的胰腺癌的一种选择。
