Paraneoplastic Acanthosis Nigricans, Leser-Trélat and Tripe Palms Associated With Gastro-Esophageal Junction Adenocarcinoma: A Case Report

Abstract

Acanthosis nigricans is a skin condition that is characterized by velvety, hyperpigmented and occasionally pruritic plaques, mostly seen in the flexural areas. It can occur as a paraneoplastic phenomenon, most frequently in association with an adenocarcinoma of gastrointestinal origin. The sign of Leser-Trelat is defined as an eruption of numerous seborrheic keratoses, and can be associated with acanthosis nigricans. Also, acanthosis nigricans can be associated with tripe palms, a velvety, warty thickening of the palms’ surface with exaggerated dermatoglyphics, and with papillomatosis of the oral mucosa. A 62-year old woman presented with a rapid onset of hyperpigmented plaques, multiple (seborrheic) warts, tripe palms and papillomatous hyperplasia of her oral mucosa. A skin biopsy confirmed acanthosis nigricans. Because of her age and the quite sudden development of the skin lesions, the paraneoplastic variant of this condition was suspected and the patient was referred to a medical oncologist. As part of extensive diagnostic screening, an upper gastro-intestinal endoscopy was performed revealing an esophageal tumor at 30 to 35 cm from the incisors. She underwent an esophagectomy after neoadjuvant chemoradiotherapy. The tumor was staged as ypT2N1M0 adenocarcinoma, which had been radically resected (R0). The tumor showed extensive histomorphological regression. During the neoadjuvant therapy the skin lesions and the mucosal swelling with which the patient initially presented regressed, and disappeared almost completely six months after surgery. The presented case shows the combination of acanthosis nigricans, the sign of Leser-Trelat, tripe palms and extensive oral papillomatosis, which led to the detection of an adenocarcinoma of the gastro-esophageal junction, a tumor that has been reported in association with malignant acanthosis nigricans. doi:10.4021/jmc217w