A 66-year-old man with a mucinous adenocarcinoma of the colon develops recurrent migratory superficial thrombophlebitis affecting the left arm, then the right leg, then the neck, despite adequate anticoagulation. This paraneoplastic manifestation results from:

• A Ectopic production of thrombopoietin by the tumor
• B Tumor-derived procoagulants and platelet activating factors causing hypercoagulability ✓
• C Immune complex deposition in deep venous valves
• D Direct invasion of the venous intima by circulating tumor cells

Explanation

This is Trousseau syndrome, migratory thrombophlebitis classically associated with mucin-secreting gastrointestinal adenocarcinomas and pancreatic cancer. Mucins and tumor-derived tissue factor and procoagulants activate clotting systemically, producing recurrent thromboses at shifting sites that resist warfarin and require heparin-based anticoagulation. Thrombopoietin affects platelet counts rather than thrombosis location, immune complexes cause vasculitis rather than phlebitis, and the process is systemic rather than due to local venous invasion.

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.