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Abstract
Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC.
Highlights
Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia
Of the neck, axillary, and inframammary regions was darkened and thickened with a velvety appearance, which is consistent with the clinical diagnosis of acanthosis nigricans (AN) (Figure 1)
The typical presentation of Renal cell carcinoma (RCC) is represented by flank pain, palpable mass, and hematuria, only up to 20% of cases will present this triad, and it is common to diagnose large tumors in its origin before any previous accompanying symptoms
Summary
Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. A 67-year-old woman sought medical attention complaining of progressive weight loss and loss of appetite over the last 10 months, which was treated with antidepressants because of the suspicion of a mood disorder In the meantime, she noticed darkening of the skin, but her mucosa, palms, and soles were spared. She noticed darkening of the skin, but her mucosa, palms, and soles were spared At the time she was hospitalized, she had lost 21 kg and presenting daily fever (38°C) accompanied by rigor and marked weakness. The abdominal computed tomography confirmed the presence of a voluminous and heterogeneous mass, measuring 13.4 × 8.6 × 7.3 cm, predominantly hypoattenuating and with heterogeneous contrast enhancement It anteriorly displaced the renal hilum, which was apparently without invasion (Figure 2).
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