A 62-year-old man presents with painless, recurrently migrating nodules along superficial veins of the leg and arm, appearing and resolving over weeks. He has also lost 8 kg in three months with vague epigastric discomfort radiating to the back. Which paraneoplastic phenomenon best explains his venous findings?

• A Marantic endocarditis with embolization
• B Migratory thrombophlebitis due to tumor-derived procoagulants ✓
• C Superficial thrombophlebitis secondary to chemotherapy extravasation
• D Behçet disease with vasculitic venous occlusion

Explanation

Trousseau syndrome, migratory thrombophlebitis, results from hypercoagulability induced by mucin-secreting adenocarcinomas, classically pancreatic carcinoma, through tumor-derived tissue factor and platelet activation. The weight loss and back-radiating epigastric pain point strongly to pancreatic cancer. Marantic endocarditis is another manifestation of the same hypercoagulable state but causes arterial embolic strokes rather than superficial venous nodules, which kills that distractor.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.