Trousseau's syndrome manifesting as multiple cerebral infarctions caused by bladder cancer

Abstract

Cerebral infarction in patients with cancer is often called Trousseau's syndrome, which is a cancer-associated hypercoagulative state that causes thrombosis; however, the syndrome is rarely caused by bladder cancer. We report a case of Trousseau's syndrome manifesting as multiple cerebral infarctions caused by advanced bladder cancer in a 46-year-old male patient. The patient died due to the infarctions in the hospital. The prognosis of patients with Trousseau's syndrome caused by advanced cancer is poor. According to changing urological clinical settings, considering the risk of Trousseau's syndrome has become crucial for urologists treating patients with advanced cancer.

Keywords: Bladder cancer; Cerebral infarction; Trousseau's syndrome; Urothelial cancer.

Fig. 1

Abdominal computed tomography. Computed tomography revealed an asymptomatic splenic infarction (A), right-side hydronephrosis and an angiomyolipoma in the left kidney (white arrow) (B), large invasive bladder cancer suggesting prostate invasion with bilateral extra-iliac lymph node enlargements (C, D).

Fig. 2

Magnetic resonance imaging (MRI) of the brain. Diffusion-weighted images (DWI) (upper). Fluid-attenuated inversion recovery images (FLAIR) (lower). Non-segmental multiple cerebral infarctions of various sizes are revealed in the cerebellum, cerebral cortex, and the cerebral white matter. Because these infarctions appeared as high-density areas using DWI and as iso- or high-density areas using FLAIR, these were ultra-acute infarctions.

Fig. 3

Histopathological findings. Hematoxylin and eosin staining. Bladder cancer resected via trans-urethral resection (A). Exhibition of muscle-invasion (B) and lymphoma-like high-grade urothelial carcinoma (C).