A 62-year-old man with weight loss and back pain develops recurrent superficial and deep venous thromboses migrating between the arms, legs, and mesenteric veins over several weeks. CT shows an unresectable mass in the body of the pancreas. This paraneoplastic phenomenon is best explained by:

• A Tumor-derived procoagulant factors and platelet activating activity ✓
• B Ectopic secretion of thrombopoietin by the tumor
• C Immune complex deposition on venous valves
• D Ectopic production of von Willebrand factor

Explanation

Migratory thrombophlebitis (Trousseau syndrome) is classically associated with pancreatic adenocarcinoma and mucin-secreting carcinomas. Pancreatic cancers elaborate procoagulants such as tissue factor and cancer procoagulant along with mucins that activate platelets directly, producing hypercoagulability that shifts from vessel to vessel. Thrombopoietin causes thrombocytosis rather than migratory thrombosis, immune complexes cause vasculitis, and ectopic vWF is not a recognized paraneoplastic mechanism.

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.