Venous thrombosis and cancer : What would Dr. Trousseau teach today?
A partir d'une revue systématique de la littérature publiée jusqu'en janvier 2016 (10 études incluant au total 2 316 patients ; âge moyen : 60 ans), cette méta-analyse évalue, en fonction de catégories d'âge et de la stratégie de dépistage, le taux de cancers occultes détectés dans les 12 mois qui suivent le diagnostic d'une thromboembolie veineuse sans cause apparente
The year 2017 marks the 150th anniversary of the publication of Dr. Armand Trousseau's Lectures on Clinical Medicine, the English translation of Clinique médicale de l'Hôtel-Dieu de Paris (1861), a compilation of lectures Trousseau delivered as physician in chief at Hôtel-Dieu de Paris hospital (1). In lecture 95, “Phlegmasia Alba Dolens” (venous thromboembolic disease), Trousseau discussed the relationship between unexplained venous thromboembolism (VTE) and the subsequent diagnosis of cancer and presented several cases to illustrate this relationship. He opined, “I have long been struck with the frequency with which cancerous patients are affected with painful edema in the superior or inferior extremities” (1), and so impressed was he by this relationship that he regarded the presence of unprovoked VTE as a sign of cancer. He never commented on the “relative frequency” (prevalence) of VTE preceding a cancer diagnosis but taught that it was frequent, and so the eponym Trousseau syndrome or Trousseau sign of malignancy—recurrent or migratory unprovoked thrombophlebitis as a precursor to the diagnosis of cancer—was minted (2). Therefore, during the past century and a half, clinicians have asked themselves the following questions: Should a patient with unprovoked VTE be evaluated for occult cancer? Is a patient's outcome affected by whether cancer is found? Was Trousseau correct in his observation?
Annals of Internal Medicine , éditorial, 2016