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A skin biopsy showed papillomatous hyperplasia of the epidermis, with hyperkeratosis and acanthosis.
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We herein describe a patient we encountered in whom mediastinal lymph node metastasis of lung cancer with an unknown primary lesion was complicated by both an endocrine abnormality and acanthosis nigricans. A 66-year-old male visited a local hospital and was diagnosed as having acanthosis nigricans. The patient was referred to our hospital for furt...
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Context 1
... 66-year-old male visited a local hospital with the chief complaints of general malaise, hyperpigmentation of the skin, and weight loss. The patient was diagnosed to have acanthosis nigricans (Fig. 1). Cushing's syndrome was Ann Thorac Cardiovasc Surg Vol. 15, No. 6 (2009) also suspected because elevations in adrenocorticotropic hormone (ACTH) and cortisol levels were noted. The patient was referred to our hospital for further examination and was hospitalized in October 2006. Examinations were carried out because malignant neoplasms and endocrine diseases have commonly been reported as underlying disorders of acanthosis nigricans. Of the tumor markers assessed, carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and carbohydrate antigen 19-9 (CA19-9) were found to have increased. The endocrine function test using dexamethasone showed a normal cortisol suppression at dexamethasone levels of 0.5 mg and 1.0 mg, indicating that the possibility of Cushing's syndrome was ruled out. Diagnostic imaging revealed no pituitary lesions. Computed tomography (CT) scans of the chest (Fig. 2) and the abdomen showed no adverse findings except for an enlargement of the mediastinal lymph node. No malignant lesions were detected in examinations of the upper gastrointestinal tract. An 18-fluoro-2-deoxy-D- glucose positron emission tomography (FDG-PET) scan also showed no changes at any sites except the mediastinal lymph node. Based on these findings, the lesion was thus considered to possibly be mediastinal lymph node metastasis of an unknown primary tumor or malignant lymphoma. A thoracoscopic biopsy of the mediastinal lymph node was performed in the following month, November. Histo- pathologically, atypical cells presented with the nucleus containing a large acidophilic nucleolus and fine nucleo- reticulum, together with palely stained cytoplasm, and some of them had adenoid structures. However, a definite diagnosis of adenocarcinoma was not made based on only the findings from hematoxylin and eosin staining (Fig. 3). Immunohistochemical staining showed the biopsy specimen to be positive for cytokeratin (CK) 7, negative for CK20, positive for thyroid transcription factor 1 (TTF-1), positive for villin, and negative for ACTH. Although a possibility of gastrointestinal tract involvement could not be categorically ruled out because the tissue was positive for villin and TTF-1, the CK pattern was not inconsistent with pulmonary ...
Citations
... Paraneoplastic syndromes in CUP patients may allow a timely diagnosis but may also increase the morbidity and mortality of patients. Our review of the literature showed that the majority of patients with CUP present one paraneoplastic syndrome and the occurrence of two syndromes is uncommon [23,24,29,35,51,54,61]. Another interesting finding in this review is the lack of reports describing the more commonly encountered paraneoplastic syndromes such as syndrome of inappropriate antidiuretic hormone, polymyalgia rheumatica and Lambert-Eaton syndrome in patients with CUP. ...
Paraneoplastic syndromes are signs or symptoms that result from tissue damage at locations remote from tumour sites. Paraneoplastic syndromes associated with cancer of unknown primary (CUP) are not well recognized as they are rarely reported. These syndromes can impair various organ functions and include endocrine, neurologic, dermatologic, rheumatologic, hematologic and several other system alterations. To our knowledge, the association between the histological CUP type and the paraneoplastic syndrome has never been assessed. In some instances, paraneoplastic syndromes can become the major clinical problems determining survival. However, they can also herald earlier the occurrence of CUP in patients with asymptomatic tumors. In this article, we review the available literature of CUP patients presenting paraneoplastic syndromes by trying to collect all available published cases during the last three decades. One additional goal of this article is to make practicing oncologists aware of the coexistence of paraneoplastic syndromes in patients with CUP.
... To the Editor, Acanthosis nigricans is a rare dermatological disease characterized by skin hyperpigmentation and wartshaped or velvet-like plaques that are typically in skin folds [1]. Very few cases of lung cancer with acanthosis nigricans have been reported [2]. We herein report one case of lung cancer with metastasis to the mediastinum and malignant acanthosis nigricans. ...
... Malignant acanthosis nigricans is rarely reported in lung cancer patients. Yoshino et al. reported a patient with acanthosis nigricans who was subsequently found to have mediastinal lymph node metastasis of lung cancer [2]. In the current case, we found evidence of lung cancer with mediastinal and retroperitoneal lymph node metastasis by CT scan and lymph node biopsy. ...
... Two forms are distinguished that may be either benign, congenital or acquired as a result of endocrinopathies, erythema nodosum or nicotinic urogastrone, or malignant, associated with cancer of various organs. Such cancers include adenocarcinomas of the abdominal cavity, thyroid, breast, esophagus or even sarcomas [12,13]. Acanthosis nigricans is also associated with other paraneoplastic conditions, such as Leser-Trelat symptom, paraneoplastic pemphigus or necrolytic migratory erythema. ...
Paraneoplastic syndromes (PNS) are remote effects of cancer that are, by definition, caused neither by invasion of the tumor or its metastases nor by infection, ischemia, metabolic and nutritional deficits, surgery or other forms of tumor treatment. The purpose of the current review was to present the challenging elements of differential diagnosis in oncology, as they may represent the main clinical problem in a patient diagnosed with cancer, even though the complete knowledge of both their clinical aspects and pathogenesis remain quite poor. This review focuses on the paraneoplastic syndromes related to dermatology and rheumatology, as the most frequent manifestations come from connective tissues that might determine a patient to ask for consultation by a general practitioner.
... A patient with bronchoalveoler carsinom is reported [21]. And only few cases with pulmonary malignancy with acanthosis nigricans are reported in the literature [22,23]. It alone may predict malignancy or may develop with other signs or occur later. ...
Some skin lesions may accompany malignancies. Acanthosis nigricans, one such lesion, is a paraneoplastic dermatosis characterized by hyperpigmented and velvety verrucose plaques observed as symetric eruptions. With this report, we aim to present a rare case of concomitant lung cancer and acanthosis nigricans. Malignant acanthosis nigricans is most commonly associated with intra-abdominal malignancies. A 65-year-old patient who had hyperpigmented, hypertrophic and symmetric verrucose lesions at the flexor surfaces of the lower and upper extremities, face, palms and the axillary region. Thoracic computed tomography demonstrated a hypodense mass lesion with a dimension of 5 x 5.5 cm at the center of basal segment bronchi of the left pulmonary lobe. Fiberoptic bronchoscopy showed that the access to the lower left lobe was almost completely obstructed by the endobronchial lesion. The result of the histopathologic examination of the endobronchial tissue biopsy was reported as non-small cell (adenocarcinoma) lung cancer. Result of the histopathologic analysis of the punch biopsy of the skin lesions was reported as acanthosis nigricans .There are no pathognomonic dermatological findings for lung cancer. In conclusion, there are skin lesions that accompany lung cancer and we believe that these should be considered for differential diagnosis.
We report a case of acanthosis nigricans associated with gastric adenocarcinoma with liver metastasis in the present study. Furthermore, we analyzed 71 cases of acanthosis nigricans reported in China and explored the relationship between acanthosis nigricans and internal organ diseases. We found that skin symptoms might be signs of the presence of malignant tumors. Malignant acanthosis nigricans is a rare paraneoplastic dermatosis. The neoplasms associated with malignant acanthosis nigricans are typically aggressive in nature, mandating an extensive search for the underlying malignancy once the diagnosis of malignant acanthosis nigricans is suspected.
Background and AimHyperpigmentation is a kind of paraneoplastic syndrome associated with lung cancer. Diffuse hyperpigmentation was reported and generally resulted from overproduction of melanocyte-stimulating hormone or adrenocorticotropic hormone. However, localized hyperpigmentation is rare for lung cancer.Methods
Here, we report a 56-year-old lung adenocarcinoma patient who developed hyperpigmentation in two palms about 3 months preceding the diagnosis and resolved gradually with the shrink of the primary tumours in lung after chemotherapy.ResultLocalized hyperpigmentation suggests that another mechanism might be involved.Conclusion
The case reminds us that any skin disorders without obvious causes in heavy smokers should be alerted as a sign of lung cancer and sometimes could be used as a marker of response to the treatment.
