Acanthosis nigricans and "tripe palm" as paraneoplastic manifestations of metastatic tumor

Abstract

Acanthosis nigricans is a common dermatosis and is most often associated with benign conditions, such as insulin resistance. It is rare as a paraneoplastic marker. As such, it is characterized by sudden onset and rapid dissemination of velvety and hyperchromic skin lesions. The term "tripe palm" refers to exaggeration of the palmar ridge pattern, which resembles the internal surface of the bovine intestinal tract. This is a paraneoplastic marker of high specificity, with 90% of the cases being associated with malignancy. We report the case of a patient with stage IV ovarian adenocarcinoma presenting acanthosis nigricans and tripe palm. Both findings are closely correlated to the neoplasm course. Keywords: Acanthosis nigricans; Neoplasm metastasis; Skin manifestations Resumo: A acantose nigricante é uma dermatose comum, mais frequentemente associada a condições benignas, como resistência periférica à insulina. É rara como marcador paraneoplásico. Como tal, é caracterizada pelo aparecimento repentino e disseminação rápida de lesões cutânas aveludadas e hipercrômicas. O termo "palma em tripa" se refere ao aumento da demarcação do sulcos cutâneos, que se assemelha à face interna do trato intestinal bovino. É um marcador paraneoplásico de alta especificidade, com 90% dos casos associados à malignidade. Relatamos uma paciente com adenocarcinoma de ovário, estágio IV, apresentando acantose nigricante e "palma em tripa"; ambos achados estão estreitamente relacionados ao curso da neoplasia. COMMUNICATIONAcanthosis nigricans is a common dermatosis and is most often associated with benign conditions, such as obesity and insulin resistance. 1 It is rare as a paraneoplastic marker. However, when related to malignancy, 90-95% of cases are associated with abdominal cavity adenocarcinomas and, in more than half of them, with gastric tumors. 2,3,4 The term "tripe palm" refers to exaggeration of palmar and sometimes plantar skin ridges, which resemble the internal surface of the bovine gastrointestinal tract. It is a paraneoplastic marker, with 90% of the cases being associated with malignancy. In this communication article, we describe acanthosis nigricans as a paraneoplastic marker and highlight the "tripe palm" finding, which is fairly unreported and reveals great specificity for malignancy. 3A 57-year-old woman presented skin thickening with exaggerated ridges and hyperpigmentation of the orbicular, perilabial, and cervical regions. The conditions had been present for two years and were associ-

Paraneoplastic cutaneous manifestations: concepts and updates*

“…9 ANM is associated with 90% of all abdominal cancers; 55-61% are of gastric origin, and adenocarcinoma is found in 70-90% of cases (Figure 2). 3,6,9,11,12 Other less associated malignant conditions include uterine, liver, intestine, pancreas, thyroid, ovary, kidney, breast, lung, bladder and gallbladder cancers, mostly consisting of adenocarcinomas. 9,11 An association with lymphomas and mycosis fungoides has also been reported.…”

Malignant Acanthosis Nigricans, Florid Cutaneous Papillomatosis and Tripe Palms Syndrome Associated with Gastric Adenocarcinoma - a Case Report

“…MAN was fi rst described by Clarke (38); it may be associated with other cutaneous markers of internal malignancies: AN commonly occurs with some of the three or all three forms of paraneoplastic lesions, fl orid cutaneous papillomatosis (FCP), lesions on the palms and soles (tripe palms; pachydermatogliphia), and multiple seborrheic keratoses (sign of LeserTrélat). Th ese paraneoplastic syndromes are considered abortive forms of MAN (19), especially as they have similar epidemiological, morphological and histological characteristics (38). However, these are special type of paraneoplastic dermatoses (39) which can occur individually (13,40,41).…”

The case of gastric adenocarcinoma applying with malign Acanthosis Nigricans

“…Deride koyulaşma, melanin birikimi ve melanosit çoğalması ile değil hiperkeratozla ilişkilidir. [4,5] OLGU SUNUMU Kırk dört yaşında erkek hasta üç-dört ay içinde gelişen deride koyulaşma ve kalınlaşma, yaygın vücut ağrısı ve kilo kaybı ile kliniğimize başvur-du. Fizik muayenesinde özellikle boyun, aksilla, inguinal bölge, el ve ayakta akantosis nigrikans ile uyumlu cilt lezyonları mevcuttu (Şekil 1).…”