Trousseau's Syndrome Presenting as Multiple Cerebral Infarctions Caused by Mucin-producing Bladder Micropapillary Urothelial Cancer

Abstract

We herein report a 70-year-old man with recurrent multiple cerebral infarctions under warfarin therapy who was finally diagnosed with Trousseau's syndrome resulting from advanced bladder cancer. A histological examination of the mesenteric lymph nodes revealed metastasis of micropapillary urothelial cancer with positive mucin markers CA125 and MUC1. Blood examinations also indicated elevated tumor markers, such as CA19-9 and CA125. To our knowledge, this is the first report of Trousseau's syndrome in a patient with bladder micropapillary urothelial cancer in which mucin involvement was clearly proven by histological and serological examinations.

Keywords: Trousseau's syndrome; bladder cancer; cerebral infarction; micropapillary urothelial cancer; mucin.

Figure 1.

Diffusion-weighted brain magnetic resonance image revealing newly developed multiple cerebral infarctions in the left cerebellum (A) and in the right parietal lobe (arrow in panel B). Fluid-attenuated inversion recovery imaging revealed hyperintensity in the left parietal lobe, indicating a previous cerebral infarction that developed a month ago (C). Magnetic resonance angiography revealed no atherosclerotic lesion (D).

Figure 2.

Abdominal X-ray (A) and computed tomography (B) images showing ileus-like images.

Figure 3.

Histological examinations of mesenteric lymph nodes obtained during surgery with Hematoxylin and Eosin staining (A) showing similar findings to those of specimens obtained in a previous hospital (B). Positive staining for GATA3 (C) and HER2 (D) indicated micropapillary urothelial cancer. Positive staining for CA125 (E) and MUC1 (F) suggested mucin production. Scale bar=100 μm.