Abstract
An 82-year-old man was in his usual state of health when henoticed the rapid appearance of seborrheic keratoses along his shoul-ders and back. Around this time, he also started to experience wors-ening nausea, constipation, dysphagia, and a 10-pound weight loss.He was evaluated with endoscopy, which revealed a large ulceratedmass along the lesser curvature of the stomach with some oozing.Biopsieswereperformedandpathologyshowedpoorly-differentiatedadenocarcinoma, signet-ring–cell type, arising in a background ofgastritis with intestinal metaplasia. Carcinoembryonic antigen wasmeasured at 1.3 ng/mL. Further work-up including a computed to-mography of the abdomen/pelvis demonstrated diffuse thickening ofthe distal stomach along with a subcentimeter hypervascular lesion inthe liver thought to represent a hemangioma. Also appreciated wassoft tissue nodularity within the gastrohepatic and gastrocolic liga-mentsandomentum.Onphysicalexam,thepatientwasnotedtohaveextensive seborrheic keratoses along his back consistent with the signof Leser-Tre´lat (LT; Fig 1). The patient underwent an exploratorylaparotomy. Intraoperatively, a large mass within the lesser curvatureof the stomach could be visualized along with adenopathy within thegastrohepaticligament.Alsonotedwerenoduleswithintheperitonealsurfaces, diaphragm, omentum, and liver. These were biopsied, andfrozen sectioning revealed metastatic carcinoma. Given the presenceof advanced disease, the patient’s tumor was deemed unresectable,and it was decided to proceed with a palliative feeding jejunostomy.This was then followed with palliative chemotherapy.LT is a rare, paraneoplastic condition characterized by the sud-den eruption of multiple seborrheic keratoses often associated withinternal malignancies. The term arises from two European surgeons,Edmund Leser and Ulysse Tre´lat, who initially and independentlycharacterized cutaneous manifestations of internal cancers in the1890s.
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