Case and Research Letters
Malignant Acanthosis Nigricans, Florid Cutaneous and Mucosal Papillomatosis and Tripe Palms in a man with gastric adenocarcinoma
Acantosis nigricans maligna, papilomatosis cutáneo-mucosa florida y paquidermatoglifia adquirida en paciente con adenocarcinoma gástrico
A. Vilas-Sueiro
, Ó. Suárez-Amor, B. Monteagudo, C. de las Heras
Corresponding author
Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, Spain
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Vilas-Sueiro, Ó. Suárez-Amor, B. Monteagudo, C. de las Heras" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Vilas-Sueiro" "email" => array:1 [ 0 => "alejandro.vilas.sueiro@sergas.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Ó." "apellidos" => "Suárez-Amor" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Monteagudo" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "de las Heras" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acantosis nigricans maligna, papilomatosis cutáneo-mucosa florida y paquidermatoglifia adquirida en paciente con adenocarcinoma gástrico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 625 "Ancho" => 1750 "Tamanyo" => 205939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratotic papules on the face. B, Inguinal region: brownish plaques with marked thickening of the skin. C, Marked hyperkeratosis on the flexor surface of the fingers with exaggerated dermatoglyphics.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We describe the case of a 67-year-old man with a clinical history of smoking, hypertension, and hyperhomocysteinemia. The patient was referred for verrucous lesions on the face that had appeared more than 1 month earlier. A dermatological examination revealed several small, hyperkeratotic lesions on the cheeks and around the mouth (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A), as well as brownish plaques in the axillary and inguinal folds (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). Both hands showed marked accentuation of the dermatoglyphics (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C). The patient reported that these symptoms had appeared abruptly within a period of less than 2 months. Based on clinical suspicion of a paraneoplastic dermatosis, additional tests were requested to identify the primary tumor.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Analyses revealed a cholestatic pattern with elevated levels of alkaline phosphatase and γ-glutamyl transpeptidase. Tumor marker analysis revealed only a slight increase of α-fetoprotein levels.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A thoracoabdominopelvic computed tomography scan revealed a lytic lesion in the posterior third of the T12 vertebral body, with slight invasion of the medullary canal, minimal thickening of the antral wall (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A), and swelling of the periaortic lymph nodes and gastrohepatic ligament lymph nodes (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B). An upper endoscopy revealed a malignant-looking ulcerated lesion with irregular borders in the area of the gastric incisura, extending towards the gastric body. Biopsy of the lesion was compatible with poorly differentiated gastric adenocarcinoma.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After treatment with palliative chemotherapy, the patient's basal state worsened and the neoplastic disease progressed with the appearance of multiple pulmonary nodules. One year after diagnosis the patient died following a respiratory infection.</p><p id="par0025" class="elsevierStylePara elsevierViewall">More than 50 types of cutaneous paraneoplastic manifestations have been described, including malignant acanthosis nigricans (MAN), florid cutaneous and mucosal papillomatosis, and acquired pachydermatoglyphia.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">MAN is characterized by the presence of brownish, symmetric, nonpruritic plaques in the skin folds and on the back of the neck that can infiltrate and present as hyperkeratotic plaques. In contrast to the benign form of acanthosis nigricans, the paraneoplastic form is characterized by abrupt onset, rapid progression, and involvement of a large skin surface area. There is a strong correlation between MAN and intra-abdominal tumors, particularly tumors of gastric origin.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Florid cutaneous and mucosal papillomatosis is characterized by the rapid appearance of verrucous papules on the trunk and extremities. The oral or genital mucosa may also be affected. This condition is most strongly correlated with tumors of gastric origin, in particular adenocarcinoma. While these lesions are clinically indistinguishable from viral warts, histologic analysis reveals marked hyperkeratosis with irregular acanthosis and papillomatosis, and no evidence of human papillomavirus infection.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Tripe palms is characterized by the enhancement of the epidermal ridges of the palms, which become slightly thickened and acquire a velvety texture, resembling the intestinal villi. In 90% to 95% of cases this condition is associated with the presence of a solid tumor.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Tripe palms has been associated with many types of cancer, the most common of which are those of the gastrointestinal tract (30%) and lungs (20%).<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The presence of all 3 of these paraneoplastic dermatoses (MAN, florid cutaneous and mucosal papillomatosis, and tripe palms) in the same patient has been previously described in the literature, suggesting potentially common etiological and pathogenic mechanisms. In fact, both tripe palms and florid cutaneous and mucosal papillomatosis are considered by some authors as clinical variants of MAN. Several studies suggest that epidermal growth factor alpha is secreted by the tumor and transported in the blood to the skin surface, where it stimulates the development of keratinocytes by activating tyrosine kinase receptors, which promote widespread mitotic and antiapoptotic cellular activity.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7–10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Of particular interest in the present case is the association of several distinct paraneoplastic cutaneous manifestations in the same patient. Recognition and identification of these conditions can enable early diagnosis and treatment of associated neoplasms, in some cases resulting in a better long-term prognosis for the patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vilas-Sueiro A, Suárez-Amor Ó, Monteagudo B, de las Heras C. Acantosis nigricans maligna, papilomatosis cutáneo-mucosa florida y paquidermatoglifia adquirida en paciente con adenocarcinoma gástrico. Actas Dermosifiliogr. 2015;106:438–439.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 625 "Ancho" => 1750 "Tamanyo" => 205939 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Hyperkeratotic papules on the face. B, Inguinal region: brownish plaques with marked thickening of the skin. C, Marked hyperkeratosis on the flexor surface of the fingers with exaggerated dermatoglyphics.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 882 "Ancho" => 1900 "Tamanyo" => 197044 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Computed tomography scan with IV contrast: thickening of the posterior gastric wall (white arrow) and lytic lesion of the T12 vertebral body (black arrow). B, Swelling of gastrohepatic ligament lymph nodes (black arrow).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Paraneoplastic cutaneous manifestations: Concepts and updates" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.A. Silva" 1 => "K.C. Mesquita" 2 => "A.C. Igreja" 3 => "I.C. Lucas" 4 => "A.F. Freitas" 5 => "S.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 9 | 14 |
| 2024 October | 86 | 48 | 134 |
| 2024 September | 102 | 36 | 138 |
| 2024 August | 129 | 61 | 190 |
| 2024 July | 113 | 44 | 157 |
| 2024 June | 108 | 46 | 154 |
| 2024 May | 84 | 41 | 125 |
| 2024 April | 93 | 31 | 124 |
| 2024 March | 81 | 29 | 110 |
| 2024 February | 64 | 21 | 85 |
| 2024 January | 67 | 31 | 98 |
| 2023 December | 58 | 16 | 74 |
| 2023 November | 53 | 43 | 96 |
| 2023 October | 68 | 35 | 103 |
| 2023 September | 78 | 32 | 110 |
| 2023 August | 60 | 16 | 76 |
| 2023 July | 56 | 62 | 118 |
| 2023 June | 79 | 34 | 113 |
| 2023 May | 96 | 43 | 139 |
| 2023 April | 51 | 27 | 78 |
| 2023 March | 68 | 36 | 104 |
| 2023 February | 63 | 28 | 91 |
| 2023 January | 37 | 31 | 68 |
| 2022 December | 48 | 35 | 83 |
| 2022 November | 30 | 31 | 61 |
| 2022 October | 36 | 21 | 57 |
| 2022 September | 32 | 43 | 75 |
| 2022 August | 29 | 39 | 68 |
| 2022 July | 25 | 34 | 59 |
| 2022 June | 32 | 32 | 64 |
| 2022 May | 73 | 26 | 99 |
| 2022 April | 71 | 45 | 116 |
| 2022 March | 54 | 39 | 93 |
| 2022 February | 64 | 24 | 88 |
| 2022 January | 80 | 47 | 127 |
| 2021 December | 60 | 45 | 105 |
| 2021 November | 50 | 46 | 96 |
| 2021 October | 63 | 58 | 121 |
| 2021 September | 42 | 38 | 80 |
| 2021 August | 54 | 48 | 102 |
| 2021 July | 49 | 33 | 82 |
| 2021 June | 48 | 31 | 79 |
| 2021 May | 55 | 39 | 94 |
| 2021 April | 186 | 108 | 294 |
| 2021 March | 81 | 23 | 104 |
| 2021 February | 100 | 42 | 142 |
| 2021 January | 47 | 23 | 70 |
| 2020 December | 43 | 21 | 64 |
| 2020 November | 43 | 15 | 58 |
| 2020 October | 31 | 11 | 42 |
| 2020 September | 55 | 20 | 75 |
| 2020 August | 25 | 26 | 51 |
| 2020 July | 30 | 16 | 46 |
| 2020 June | 25 | 27 | 52 |
| 2020 May | 28 | 22 | 50 |
| 2020 April | 26 | 19 | 45 |
| 2020 March | 29 | 19 | 48 |
| 2020 February | 4 | 3 | 7 |
| 2020 January | 4 | 4 | 8 |
| 2019 December | 4 | 0 | 4 |
| 2019 November | 4 | 1 | 5 |
| 2019 October | 0 | 7 | 7 |
| 2019 September | 2 | 4 | 6 |
| 2019 August | 4 | 3 | 7 |
| 2019 July | 4 | 6 | 10 |
| 2019 June | 6 | 13 | 19 |
| 2019 May | 4 | 29 | 33 |
| 2019 April | 11 | 2 | 13 |
| 2019 March | 3 | 16 | 19 |
| 2019 February | 1 | 0 | 1 |
| 2019 January | 6 | 0 | 6 |
| 2018 December | 0 | 2 | 2 |
| 2018 November | 7 | 0 | 7 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 4 | 3 | 7 |
| 2018 August | 0 | 7 | 7 |
| 2018 July | 0 | 3 | 3 |
| 2018 June | 0 | 1 | 1 |
| 2018 May | 0 | 5 | 5 |
| 2018 April | 0 | 1 | 1 |
| 2018 February | 20 | 6 | 26 |
| 2018 January | 28 | 13 | 41 |
| 2017 December | 30 | 14 | 44 |
| 2017 November | 35 | 9 | 44 |
| 2017 October | 25 | 8 | 33 |
| 2017 September | 27 | 22 | 49 |
| 2017 August | 27 | 8 | 35 |
| 2017 July | 24 | 27 | 51 |
| 2017 June | 27 | 26 | 53 |
| 2017 May | 26 | 10 | 36 |
| 2017 April | 27 | 18 | 45 |
| 2017 March | 21 | 31 | 52 |
| 2017 February | 28 | 11 | 39 |
| 2017 January | 18 | 17 | 35 |
| 2016 December | 32 | 6 | 38 |
| 2016 November | 36 | 15 | 51 |
| 2016 October | 30 | 14 | 44 |
| 2016 September | 0 | 9 | 9 |
| 2016 August | 0 | 5 | 5 |
| 2016 July | 10 | 5 | 15 |
| 2016 June | 10 | 6 | 16 |
| 2016 May | 15 | 1 | 16 |
| 2016 April | 8 | 2 | 10 |
| 2016 March | 2 | 1 | 3 |
| 2016 February | 4 | 3 | 7 |
| 2016 January | 8 | 3 | 11 |
| 2015 December | 8 | 1 | 9 |
| 2015 November | 0 | 4 | 4 |
| 2015 October | 0 | 5 | 5 |
| 2015 September | 0 | 2 | 2 |
| 2015 August | 0 | 4 | 4 |
| 2015 June | 4 | 6 | 10 |
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