Leser-Trélat Research Articles

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

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

The Leser–Trelat sign is a associated with acute myeloid leukemia

Dear Editor, A 69-year-old male was admitted with fatigue. His physical examination was normal except that he was pallor. Dermatologic examination revealed multiple eruptive seborrheic keratoses, which he reported had developed over the previous 2 to 3 years (Fig. 1a–b). WBC was 1.9×10/L, hemoglobin 6.4 g/dl, hematocrit 19.3%, and platelet count 18×10/L. There were blastic cells on peripheral smear and bone barrow aspiration. Bone marrow aspiration revealed hypercellular particles with erythropoiesis and megakaryopoiesis being depressed. The differential counts revealed blasts at 76%, promyelocytes 2%, myelocytes 12%, metamyelocytes 4%, and neutrophils 6%. Dysgranulopoiesis and hypolobation was seen in the granulocytic series. Acute myeloid leukemia with multilineage dysplasia according to WHO classification (AML-M1 according to FAB) was diagnosed after bone marrow biopsy and flow cytometry. The Leser– Trelat sign is an eruptive appearance or increase in itchy multiple seborrheic keratoses. This process occurs in a short period of time, and is sign of internal malignancy. The cutaneous findings were consistent with the diagnosis of the Leser–Trelat sign, which is usually associated with gastrointestinal adenocarcinoma. This sign is a controversial physical finding, however, since seborrheic keratoses are common with aging (except sudden appearance, rapid increase in size and number). Induction chemotherapy with mitoxantrone 10 mg/m IV over 30 min on days 1–3 and cytosine arabinoside 100 mg/m IV over 30 min every 12 h on days 1–7 was initiated. Now, he is alive and in remission for 3 months. But these lesions remained unchanged. To our knowledge, this is the first report of an association of the Leser–Trelat sign with acute myeloid leukemia. Fig. 1 Multiple eruptive seborrheic keratoses

The Leser-Trélat sign is associated with nasopharyngeal carcinoma: case report and review of cases reported in China

The sign of Leser-Trélat (LT) is defined as the sudden eruption of multiple seborrhoeic keratoses (SKs), or increase in the number and size of existing SKs, associated with an underlying malignancy. A 75-year-old man was admitted to our hospital with dyspnoea and multiple verrucous papules that had been developing gradually over the previous 30 years. During the 3 months before presentation, the number of SKs on his chest and back had increased rapidly. A diagnosis of nasopharyngeal carcinoma was made based on results of computed tomography, endoscopy and biopsy examinations. The patient is receiving radiotherapy at present. To our knowledge, this is the first case of the Leser-Trélat sign associated with nasopharyngeal carcinoma.

Leser–Trelat sign in metastasized malignant melanoma

The Leser-Trelat sign is defined as the association of multiple, eruptive seborrheic keratoses with an internal malignancy of a usually advanced stage. We report the case of malignant melanoma in an 82-year-old man covered with hundreds of greyish-dark seborrheic keratoses resembling a Christmas tree pattern, who was diagnosed with metastasized malignant melanoma involving the parotid gland and lymph nodes. Though the pathogenesis of Leser-Trelat sign is still unknown, spontaneous regression of the seborrheic keratoses following tumor reduction described in some cases argues for a paraneoplastic origin of this highly instructive clinical entity. Physicians should consider a workup for internal malignancy in patients presenting with multiple eruptive seborrheic keratoses.

Acanthosis nigricans and the sign of leser-trelat associated with primary brain tumor: Case report

The authors present a case of a female patient a 26-year old pensioner from Zmajevo, who developed skin changes in the neck region, armpits and groins, as well as in submammal folds during the 10 years period. The changes include dark-brown hyper?pigmentation associated with sudden eruption of a large number of benign skin tumors and dark-brown seborrheic keratosis on trunk and extremities. In 1998, after magnetic resonance imaging, primary brain tumor of astrocytoma type with low grade of malignity was discovered in thalamus region. The patient developed the above-mentioned skin changes since then. According to neurosurgical findings, the brain tumor is inoperable, so skin changes are persistent and stationary. Clinical changes correspond to paraneoplastic form of acanthosis nigricans. Numerous skin tumors histopathologically match seborrheic keratosis and reveal the clinical features of the sign of Leser-Trelat. It is interesting that in the same patient there are both, obligatory and optional, paraneoplastic dermatoses associated with malignant brain tumor.

Acanthosis nigricans, tripe palms and the sign of Leser–Trelat in a patient with a benign hepatic neoplasia

Journal of the European Academy of Dermatology and VenereologyVolume 21, Issue 6 p. 846-848 Acanthosis nigricans, tripe palms and the sign of Leser–Trelat in a patient with a benign hepatic neoplasia AFE Da Costa França, Corresponding Author AFE Da Costa França Departments of Dermatology, *Corresponding author, tel. +55 19 3521 7602; fax +55 19 3289 4107; E-mail: andreafeloy@ig.com.brSearch for more papers by this authorNS Siqueira, NS Siqueira Oncology andSearch for more papers by this authorJBC Carvalheira, JBC Carvalheira Oncology andSearch for more papers by this authorMJA Saad, MJA Saad Internal Medicine, Campinas, São Paulo, Brazil.Search for more papers by this authorEM Souza, Corresponding Author EM Souza Departments of Dermatology, *Corresponding author, tel. +55 19 3521 7602; fax +55 19 3289 4107; E-mail: andreafeloy@ig.com.brSearch for more papers by this author AFE Da Costa França, Corresponding Author AFE Da Costa França Departments of Dermatology, *Corresponding author, tel. +55 19 3521 7602; fax +55 19 3289 4107; E-mail: andreafeloy@ig.com.brSearch for more papers by this authorNS Siqueira, NS Siqueira Oncology andSearch for more papers by this authorJBC Carvalheira, JBC Carvalheira Oncology andSearch for more papers by this authorMJA Saad, MJA Saad Internal Medicine, Campinas, São Paulo, Brazil.Search for more papers by this authorEM Souza, Corresponding Author EM Souza Departments of Dermatology, *Corresponding author, tel. +55 19 3521 7602; fax +55 19 3289 4107; E-mail: andreafeloy@ig.com.brSearch for more papers by this author First published: 12 June 2007 https://doi.org/10.1111/j.1468-3083.2006.02053.xCitations: 9 DOI: 10.1111/j.1468-3083.2006.02053.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume21, Issue6July 2007Pages 846-848 RelatedInformation

The Sign of Leser–Trélat

A healthy 65-year-old man presented with a 4-month history of left flank pain and nocturia. Dermatologic examination revealed multiple eruptive seborrheic keratoses, which he reported had developed over the previous 1 to 2 years (Panels A and B). Abdominal ultrasound examination and computed tomography (CT) revealed a localized mass (7 cm by 5 cm in diameter) of the left lower renal pole with central necrosis. A left total nephrectomy was performed, and histopathological examination confirmed a renal-cell carcinoma. The tumor infiltrated to, but did not penetrate, Gerota's fascia. The cutaneous findings were consistent with the diagnosis of the Leser–Trelat sign, . . .

Surrounding ipsilateral eruptive seborrheic keratosis as a warning sign of intraductal breast carcinoma and Paget's disease (Leser Trelat sign)

Paget disease of the breast, most often occurs in middle-aged women. Leser-Trelat sign is a rare cutaneous manifestation of internal malignancy that is usually associated with visceral-type adenocarcinoma. We report a patient with Paget disease of the nipple and intraductal carcinoma who presented with ipsilateral, eruptive grouped seborrheic keratoses of the areola and nipple of the breast.

Forensic Dermatopathology and Internal Disease

The gross and microscopic analysis of skin lesions at autopsy can help the pathologist understand diseases and injuries inflicted premortem, perimortem, or postmortem. From January 2003 to January 2004, skin findings at autopsy were closely examined by a dermatologist and sampled for microscopic analysis at the Southwestern Institute of Forensic Sciences. Dermatologic abnormalities in some of these cases led to the discovery of internal disease and allowed for a more complete understanding of the pathologic disease processes affecting the individual. We present four autopsy cases with skin manifestations of internal disease, including pseudoxanthoma elasticum, calciphylaxis, the sign of Leser Trelat, and papular mucinosis, and demonstrate the usefulness of the dermatological assessment at autopsy. In all cases, discovery of these skin lesions and internal disease manifestations allowed contributing factors to the death of the individual to be uncovered.

A Case of Leser-Trelat Sign Associated with Adenocarcinoma of the Rectum

A Case of Leser-Trelat Sign Associated with Adenocarcinoma of the Rectum

Transient eruptive seborrheic keratoses associated with erythrodermic psoriasis and erythrodermic drug eruption: Report of two cases

The appearance of multiple seborrheic keratoses in association with underlying internal malignancy (known as the sign of Leser-Trelat) has generated much discussion and debate in the literature. However, comparatively few case reports exist that examine the appearance of multiple seborrheic keratoses associated with exfoliative erythroderma without underlying malignancy. We report 2 cases in which multiple, biopsy-proven seborrheic keratoses appeared in conjunction with erythrodermic skin eruptions. The underlying diseases in these 2 patients included psoriasis and an eczematous drug eruption; in both cases the erythroderma resolved with appropriate treatment. After resolution of the erythroderma, the newly developed seborrheic keratoses proceeded to involute and gradually fall off. Neither of the patients exhibited any evidence of internal malignancy. These cases represent the first reports of psoriasis and drug eruption as causes of erythroderma-induced transient eruptive seborrheic keratoses. Clinical and pathologic findings are consistent with previous descriptions of this entity. (J Am Acad Dermatol 2001;45:S212-4.)

The leser-trelat sign in association with carcinoma of the ampulla of vater

A 45-yr-old woman was admitted to our hospital for surgical treatment of obstructive jaundice. She was treated by a standard pancreatoduodenectomy (Whipple procedure). The biopsy of the specimen disclosed an adenocarcinoma of the ampulla of Vater. Six months before the appearance of the obstructive jaundice, she noted a sudden onset of many seborrheic keratoses on the upper part of her trunk and upper extremities. This, to our knowledge, is the first case of Leser-Trelat sign associated with adenocarcinoma of the ampulla of Vater.

The Leser-Trelat Sign in Association With Carcinoma of the Ampulla of Vater

A 45-yr-old woman was admitted to our hospital for surgical treatment of obstructive jaundice. She was treated by a standard pancreatoduodenectomy (Whipple procedure). The biopsy of the specimen disclosed an adenocarcinoma of the ampulla of Vater. Six months before the appearance of the obstructive jaundice, she noted a sudden onset of many seborrheic keratoses on the upper part of her trunk and upper extremities. This, to our knowledge, is the first case of Leser-Trelat sign associated with adenocarcinoma of the ampulla of Vater.

Evidence is lacking for a synergistic or additive effect of combination extracorporeal photopheresis with interferon alfa for cutaneous T-cell lymphoma

Evidence is lacking for a synergistic or additive effect of combination extracorporeal photopheresis with interferon alfa for cutaneous T-cell lymphoma

Coexistence of acanthosis nigricans and the sign of Leser-Trélat in a patient with gastric adenocarcinoma: A case report and literature review

The association of acanthosis nigricans (AN) with the sign of Leser-Trélat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage IV poorly differentiated, diffuse type, adenocarcinoma of the gastric antrum was diagnosed. The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed. (J Am Acad Dermatol 2000;42:357-62.)

Ｌｅｓｅｒ‐Ｔｒｅｌａｔ徴侯を呈した早期胃癌と進行直腸癌の２例

腫瘍随伴皮膚病変群に属するLeser-Trélat徴候 (以下, L-T徴候と略記) は突然出現し急速にその大きさと数を増すseborrheic keratosisと定義され, 同徴候を伴った内臓癌症例の2例を経験したので報告する. 症例1: 73歳, 男性. 主訴: 皮膚掻痒感. 現病歴: 平成9年3月初旬から頸部の老人性疣贅が短期間に数と大きさを増し, 痒みを伴うようになった. L-T徴候と考え精査したところ胃体上部にIIc病変を認めたため噴門側胃切除術を施行した. 中分化型管状腺癌, stage Iaであった. 症例2: 72歳, 男性. 主訴: 食欲低下. 現病歴: 平成9年1月頃より食欲不振, 便柱の狭小化があり, 同時にL-T徴候を認めた. 2月の検診で便潜血反応陽性のため精査したところRsに2型病変を認め低位前方切除術を施行した. 中分化腺癌, stage IIIaであった. L-T徴候を認めた場合内臓悪性腫瘍を伴っている可能性が高く, 臨床的には重要な所見と考えられた.

口腔乳頭腫症にＬｅｓｅｒ‐Ｔｒ´ｅｌａｔ徴候を伴った悪性黒色表皮腫の１例

Acantosis nigricans is an uncommon dermatologic disorder with papillary proliferation, pigmentation, and hyperkeratosis that is associated with malignant tumors in internal organs. We report on an elderly patient who had malignant acantosis nigricans associated with oral florid papillomatosis and Leser-Trelat sign. Advanced gastric cancer was found after detecting oral papillomatosis and dermal symptoms in this patient.

Multiple squamous cell carcinomas in situ in vitiligo lesions after long-term PUVA therapy

2. Berman A, Winkelmann R. Appearance in course of exfoliative erythroderma and regression associated with histologic mononuclear cell inflammation. Arch Dermatol 1982;118:615-8. 3. Schwengle L, Rampen F. Eruptive seborrheic keratoses associated with erythrodermic pityriasis rubra pilaris. Acta Derm Venereol (Stockh) 1988;68:443-5. 4. Holdiness M. The sign of Leser-Trelat. Int J Dermatol 1986;25:564-72. 5. Williams N. Acanthoma appearing after eczema. Br J Dermatol 1956;68:268-71. orrheic keratoses were localized and occurred several months postoperatively. Therefore this appears to be a case of eruptive, confluent seborrheic keratoses associated with a graft site. We might hypothesize that in this case, the growth factors being induced by the healing graft site stimulated appearance of the seborrheic keratoses locally. To our knowledge, this is the first reported case of postoperative eruptive seborrheic keratoses.

黒色表皮腫とＬｅｓｅｒ‐Ｔｒｅ´ｌａｔ徴候を伴った胃癌

74歳の男の患者が全身のそう痒および四肢の疣贅状の皮疹を主訴に来院した。半年前から全身のそう痒と疣贅状皮疹の出現, 拡大, 増悪があり, 初診時, 顔面と後頚部, 腋窩に黒褐色の色素沈着を伴う乳頭状の皮膚を示し, 悪性黒色表皮腫と診断した。躯幹には, 多数の脂漏性角化症様皮疹があり手背, 下肢, 足背には大豆大までのそう痒を伴う疣贅状皮疹を認めた。全身検索を施行し, 病期分類Stage IVの胃癌が発見されLeser-Trélat徴候を伴った黒色表皮腫と診断した。皮疹およびそう痒は胃切除術施行後, 次第に軽減している。本症例は, 主に四肢に現れた疣贅状皮疹が脂漏性角化症か尋常性疣贅か診断が困難であった。

A case of colonic cancer with Leser-Trelat sign.

A case of colonic cancer with Leser-Trelat sign.