Papilomatose cutânea florida e acantose nigricante maligna reveladoras de neoplasia gástrica

Abstract

This paper reports the case of a 57-year-old, previously healthy male with no systemic symptoms who over a short period of time developed multiple wart-like lesions on his trunk, limbs and face, typical lesions of acanthosis nigricans in the major body folds and tripe palms. Diagnostic tests revealed a metastatic gastric adenocarcinoma. Despite the implementation of therapy, which had a transient effect on the tumor and skin lesions, the patient died in 14 months. The association of these three paraneoplastic dermatoses (florid cutaneous papillomatosis, acanthosis nigricans maligna and tripe palms) in the same patient, apparently with a common pathogenic mechanism, is noteworthy. Keywords: Acanthosis nigricans, paraneoplastic syndromes; Stomach neoplasms Resumo: Apresenta-se o caso clínico de um doente de 57 anos, previamente saudável, sem sintomatologia sistêmica, que, num curto intervalo de tempo, desenvolve múltiplas lesões semelhantes a verrugas virais no tronco, membros e face, lesões típicas de acantose nigricante nas grandes pregas e uma queratodermia difusa palmar com paquidermatoglifia. Os exames complementares de diagnóstico revelaram uma neoplasia gástrica metastizada. Apesar da instituição da terapêutica, com efeito transitório na neoplasia e nas lesões cutâneas, o doente viria a falecer em 14 meses. Salientamos a associação destas três dermatoses paraneoplásicas num mesmo paciente: papilomatose cutânea florida, acantose nigricante maligna e tripe palms que parecem ter um mecanismo patogênico comum.

Paraneoplastic cutaneous manifestations: concepts and updates*

“…Underlying tumors present in patients with ANM tend to have an aggressive behavior, which leads to a mean survival of 2 years after the diagnosis of ANM. 3,11,13 …”

“…TGF-α would be structurally similar to the epidermal growth factor (EGF-α), interacting with this receptor present in the surface of epidermal cells. 2,3,11,13 So far, no factor has been conclusively identified. 6 …”

Malignant acanthosis nigricans, florid cutaneous papillo matosis and tripe palms syndrome associated with gastric adenocarcinoma

“…Florid cutaneous papillomatosis is characterized by sudden eruption of multiple verrucous skin lesions, located primarily on the dorsal surface of hands and wrists. The clinical manifestation is difficult to distinguish from common warts, however histological features typical of viral warts, like epidermal vacuolization or eosinophilic infiltration are not present [6]. The progression of underlying neoplasia including metastases usually result in more generalized development of skin lesions.…”

“…We present those three syndromes in the case of one patient associated with gastric adenocarcinoma what, to our best knowledge, was published before only once [6]. …”

Oral malignant acanthosis nigricans associated with endometrial adenocarcinoma

“…2,4 Malignant acanthosis nigricans is associated with a tumor, most commonly of the stomach or gut. 5 The percentage of paraneoplastic syndrome occurrence simultaneous with the intra-abdominal cancers is about 61.3%, while the rates before and after the detection of intra-abdominal cancers are 17.6% and 21%, respectively. 6 The etiology and pathogenesis of malignant acanthosis nigricans remains unclear.…”