Leser-Trélat Research Articles

Leser–Trelat sign in cosmetologist’s practice

LeserTrelat syndrome (eruptive seborrheic keratosis) is an unusial paraneoplastic dermatosis characterized by sudden appearance of seborrheic keratomas on the skin and a progressive increase of their number. This condition was first described in 1901 by the German surgeon E. Leser and the French surgeon U. Trelat. It occurs with the same frequency in both men and women aged 40+. The etiology and pathogenesis have not been studied in detail, however, there is evidence that the development of the syndrome may be associated with stimulation of the epidermal growth factor, which leads to stimulation of keratinocytes. The manifestation of the syndrome is usually start at the same time with cancer development, mostly it can be combained with adenocarcinoma of the gastrointestinal tract (47.7%), with intestinal carcinoma (32%), with lymphoproliferative diseases (21%), less often with malignant neoplasms of the lungs, breast, prostate.
 The clinical picture of the LeserTrelat sign is characterized by the sudden appearance оf seborrheic keratomas, which have typical clinical and histological signs. The most typical localization of seborrheic keratosis are back and chest (76%), limbs (18%), face (21%), abdomen (15%), neck (13%), armpits (6%), inguinal folds (3%). Keratosis can appear rapidly, over several months or even weeks. The rapid appearance of multiple seborheic keratomas may precede or develop with the oncological process in the internal organs.
 Treatment is carried out at the same time with the establishment and treatment of the underlying disease and consists in removing the largest keratomas by destructive methods (surgical excision, radiowave method, cryodestruction, electrocoagulation).
 The prognosis is favorable if paraneoplastic process was early detected.
 The article describes clinical cases of multiple seborrheic keratosis and the tactics of examining this group of patients.

The sign of Leser-Trelat an undervalued information: a report of case

The sign of Leser-Trelat an undervalued information: a report of case

Case report of Leser-Trelat sign as sequela of an atypical inflammatory process.

BackgroundLeser-Trelat sign is a rare paraneoplastic syndrome in which one main characteristic presented is an eruption of multiple seborrheic keratoses around different areas of the body. This syndrome has been associated with multiple gastrointestinal malignancies, especially adenocarcinoma of stomach and colon.Case reportWe report a 70-year-old male who presented to the surgery clinic complaining of a persistent lower abdominal pain for the past 2 months. The pain was associated with weight loss and the gradual appearance of multiple seborrheic keratoses in his body. The patient was admitted to the hospital for further evaluation, a CT scan shows an 8.1 × 5.2 cm mass in the mid mesentery and laboratories shows anemia and positive fecal occult blood. The patient was scheduled for an exploratory laparotomy. During the surgery, a large mass was found arising from the ascending colon with invasion into the adjacent sigmoid colon. The mass was sent to pathology and shows a foreign body granuloma. In addition to the surgery, the patient undergoes an endoscopic evaluation to rule out a malignancy from the upper gastrointestinal system, no masses or lesions were found.ConclusionThis is the first case reported, as far as our knowledge, of a foreign body granuloma in the association of Leser-Trelat sign. Foreign body granulomas are associated with multiple cellular signaling and this could be the source of the association of the Leser-Trelat sign. Further evaluation is needed to have a better understanding of the association between the Leser-Trelat sign and the formation of a foreign body granuloma.

Leser trelat znak u dijagnozi okultnih neoplazmi-prikaz slučaja

Leser-Trélat (LT) sign (syndrome) is a rare, distinctive clinical phenomenon that is manifested by a sudden, eruptive, appearance of multiple itchy seborrheic keratoses (SK) that sometimes coincide with occult malignancy. A 73-year-old patient came for examination of numerous, large seborrheic keratoses (SK) on the skin. According to the patient's statement, SK did not occur suddenly and "eruptively". Nevertheless, ultrasound and endoscopic evaluation were suggested to the patient to exclude the Leser-Trélat phenomenon. The patient was then diagnosed with an occult, asymptomatic rectal neoplasm. The occurrence of numerous seborrheic keratoses (especially if they are "eruptive", large and bizarre in shape), should raise suspicion of LT phenomenon, or internal malignancy in the patient, and result in relevant diagnostic procedures to detect possible latent malignancy. It would be wise for the doctors of all disciplines to be acquainted with the existence of the LT sign (syndrome) and possible clinical implications of it.

S2389 Greater Physical Exams Identify Leser-Trelat

Introduction: Leser-Trelat sign, characterized by a sudden-onset explosion of seborrheic keratoses, is a rare cutaneous paraneoplastic syndrome indicative of an internal malignancy, most commonly rectal, gastric, and colon cancers, with gastric being the most frequent. We present a case of Leser-Trelat sign in the setting of no known malignancy and a periampullary tubulovillous adenoma. Case Description/Methods: Patient is a 77-year-old male with atrial fibrillation (on Apixaban), moderate cognitive impairment, type II diabetes, 57 pack-year smoking history, and prostate cancer (s/p resection in 2009) who presented with low energy, loss of appetite and a 20-pound unintentional weight loss over 1 month. On exam, he did not have any signs of overt bleeding, however, he had periumbilical hyperpigmented ill-defined patches and numerous diffuse warty hyperpigmented lesions throughout his back. Patient was uncertain how long the periumbilical darkening had been present; however, he stated that the lesions on his back developed suddenly 1 year ago. His labs on admission were notable with a hemoglobin of 4.8 (10.6 two months ago) and ferritin of 17. EGD and subsequent endoscopic ultrasound with fine needle aspiration showed a 3 cm non-bleeding, fungating periampullary duodenal mass consistent with a tubulovillous adenoma. Discussion: Patient presented with iron deficiency anemia, unintentional weight loss, Leser-Trelat sign, and acanthosis nigricans. This was concerning for a malignancy, however only a benign periampullary duodenal tubulovillous adenoma was found. Colonoscopy, CMP, CXR, SPEP and UPEP were normal. Patient is planning complete his malignancy and iron deficiency work-up with an outpatient CT scan and capsule endoscopy. Although further work-up is imperative to fully exclude a cancer given these classic malignancy associated skin findings, if no malignancy is found, this may be the first case of a tubulovillous adenoma demonstrating Leser-Trelat sign and acanthosis nigricans.Figure 1.: Leser-Trelat Sign.

Eruptive seborrheic keratosis: A perilous clue.

An abrupt increase in seborrheic keratoses in patients with an underlying malignancy is called the Leser-Trelat sign.

Leser-Trélat sign as a rare manifestation of cutaneous melanoma.

Leser-Trélat Sign (LTS) is a rare paraneoplastic syndrome characterized by the sudden eruption of multiple seborrheic keratoses in patients with internal malignancy, commonly localized in the gastrointestinal tract. We report an 80-year-old female patient showing a rapid increase in the number and size of seborrheic keratosis associated with the diagnosis of a cutaneous nodular melanoma (Breslow thickness: 4.5 mm) located on the right flank. After the excision of melanoma, subsequent staging procedures resulted negative, moreover no evidence of melanoma recurrence and no changes of the seborrheic keratoses was detected after a follow-up of 52 months. Although the association between melanoma and Leser Trelat sign is rare, an accurate skin examination with the aid of dermatoscopy searching for undiagnosed skin cancers, should be suggested in patient with sudden eruption of keratosis seborrheic to early diagnose and treat a possible melanoma.

Cutaneous paraneoplastic syndromes

A variety of cutaneous abnormalities can be seen in patients with malignant diseases, some of which are infectious, with others representing direct involvement of the skin by the underlying disorder. Yet another group of lesions can be regarded as associated markers of the malignant process, and, as such, are termed "paraneoplastic." This review considers the latter collection of conditions, grouping them by the generic type of malignancy that is usually linked to the paraneoplasia. Some of the processes show a predominant association with alimentary tract malignancies (acanthosis nigricans, acrodermatitis paraneoplastica, florid cutaneous papillomatosis, necrolytic migratory erythema, palmoplantar keratoderma, pancreatic fat necrosis, and pityriasis rotunda). Others are usually linked to a hematolymphoid malignancy (acquired ichthyosis, exfoliative erythroderma, necrobiotic xanthogranuloma, pemphigus paraneoplastica, plane xanthoma, pyoderma gangrenosum, scleromyxedema, Sweet syndrome, and leukocytoclastic vasculitis). Finally, yet another collection of paraneoplastic skin disorders can associate themselves with anatomically-diverse malignancies (Leser-Trelat syndrome, Trousseau syndrome, dermatomyositis, erythema gyratum repens, hypertrichosis lanuginosa acquisita, papuloerythroderma of Ofuji, tripe palms, and multicentric reticulohistiocytosis). Recognition of these processes by the pathologist can be a valuable step in the characterization of underlying malignant diseases.

Leser-Trélat syndrome associated with cancer larynx : A case report

Leser-Trelat syndrome (LTS) is a rare cutaneous paraneoplastic syndrome that barely affects patients with head and neck cancer. Here we present a case of 58-years old male presented with skin manifestation consistent with a sign of Leser-Trelat. A close investigation of the patient revealed that he had a recurrent laryngeal squamous cell carcinoma. The described case is the fifth case of a Leser-Trelat syndrome with squamous cell carcinoma of the larynx and the sixth to be reported in the head and neck squamous cell carcinoma. Thus sudden development of paraneoplastic dermatoses is recurrently a forewarning progression of the malignancy.

The sign of leser-trélat: think in the adenocarcinoma of the lung.

The Leser-Trelat sign is the sudden appearance and rapid increase in the size and number of seborrheic keratoses in association with an underlying malignant disease. It is usually associated with adenocarcinoma, most frequently of the colon, breast, or stomach, exceptionally of the lung. We reported a case of patient 70-year-old man; one year ago, an increasing number of pruriginous skin lesions suddenly appeared. The progression was marked 4 months later by deterioration of the general state and dyspnea of exercise. Dermatologic examination revealed multiple seborrheic keratoses, a chest radiograph depicting complete right lung ate revealed a white lung, chest CT scan showing right lung atelectasis with obstruction of right main bronchus and right pleural effusion. The histopathologic study of the biopsy bronchial fibroscopy reported a lung adenocarcinoma. Patient was dead one week later. Our observation report association of the sign of leser-trelat with occult adenocarcinoma of the lung. Eruption of seborrheic keratoses has also been observed with benign neoplasms, pregnancy, human immunodeficiency virus infections, which indicate that the leser-trelat sign is not very specific. Despite these concerns, the eruption of multiple seborrheic keratoses should continue to trigger the thought of an internal malignancy in the differential diagnosis.

Leser—Trélat syndrome in patients with melanoma

Leser—Trélat syndrome in patients with melanoma

Leser-Trelat sign associated with pancreatic cancer

The objective of the study was to assess the prevalence of anaemia in the immediate postpartum period (48–72 h), determine the risk factors and the value of haemoglobin before birth to reduce postpartum anaemia.A prospective, observational and longitudinal study that included 1426 women who delivered consecutively and agreed to participate in the study. Different variables, analytical, epidemiological, foetal and maternal symptoms were studied.The prevalence of anaemia in the postpartum period was 49.7%. The most important risk factors were antepartum anaemia and type of delivery. The types of delivery most influencing postpartum anaemia were, forceps (82.3%), the ventouse 67%, caesarean section (58.2%) and vaginal delivery (37.2%). In the multivariate study was found as the most important independent risk factors, the haemoglobin in the delivery day (OR 6.16, CI: 3.73–10.15) and instrumental delivery (OR: 4.61, CI: 3.44–6.19). Other independent risk factors were haemoglobin in the third trimester, episiotomy and perineal tears, ethnicity, birth weight, parity and intra/postpartum complications.Anaemia in the immediate postpartum is a prevalent problem. The factors most associated postpartum anaemia were antepartum anaemia and instrumental delivery. If patients arrive at the day of delivery with haemoglobins ≥12.6 g/dl and were restricted to necessary instrumented deliveries and caesarean sections, episiotomies and we could avoid perineal tears we can decrease anaemia in the immediate postpartum period very significantly.El objetivo del estudio fue evaluar la prevalencia de la anemia en el posparto inmediato (48-72 h), determinar los factores de riesgo y el valor óptimo de la hemoglobina antes del parto para reducir la anemia.Estudio prospectivo, observacional y longitudinal que incluyó a 1.426 mujeres de forma consecutiva que accedieron a participar en el estudio. Se estudiaron diferentes variables, analíticas, epidemiológicas y clínicas tanto fetales como maternas.La prevalencia de anemia en el posparto inmediato fue del 49,7%. Los factores de riesgo más importantes fueron la anemia preparto y el tipo de parto. Con el fórceps hubo un 82,3% de anemia posparto, con el vacuum un 67%, con la cesárea un 58,2% y con el parto eutócico un 37,2%. En el estudio multivariado se encontraron como factores de riesgo independientes más importantes: la hemoglobina el día del parto (OR: 6,16; IC: 3,73-10,15) y el parto instrumentado (OR: 4,61; IC: 3,44-6,19). Otros factores de riesgo independientes fueron la hemoglobina del tercer trimestre, la episiotomía y los desgarros perineales, la etnia, el peso del neonato, la paridad y las complicaciones intra- y/o posparto.La anemia en el posparto es un problema frecuente. Los factores que más se asociaron fueron el parto instrumentado y la anemia preparto. Si las pacientes llegaran al día del parto con hemoglobina ≥ 12,6 g/dl y optimizáramos la tasa de partos instrumentados y cesáreas, restringiendo las episiotomías sin aumentar los desgarros perineales de alto grado podríamos conseguir una disminución muy significativa de la anemia en el posparto inmediato.

Don’t Forget the Skin: 4 Common Dermatologic Manifestations of Internal Malignancy

The skin is a unique marker for malignancy as these cutaneous manifestation not only often precede the development of other symptoms, but also often cause patients to seek medical attention sooner than they would for other symptoms. Common cutaneous markers for malignancy include: acanthosis nigricans, carcinoid syndrome, Leser-Trelat sign, and necrolytic migratory erythema. Although these skin signs can also be associated with benign disease, the clinician should have a low threshold for carefully evaluating patients with a cutaneous complaint for underlying systemic disease, as these signs are often harbingers of underlying malignancy.

Distant skin metastases as primary presentation of gastric cancer.

Distant gastric metastasis to the skin is uncommonly a presenting symptom, although nonspecific paraneoplastic syndromes with dermatologic manifestation including diffuse seborrheic keratoses (Leser-Trelat sign), tripe palms, and acanthosis nigricans have been described in the literature. We report here the case of a 49-year-old woman with gastric adenocarcinoma who presented with cutaneous metastasis as an initial symptom. In our case, metastatic skin lesions responded significantly to EOX chemotherapy (epirubicin+oxaliplatin+capecitabine) despite progression of systemic disease. In similar presentations, a high index of clinical suspicion and skin biopsy are important.

Leser-Trélat Bulgusu Olan Bir Olgu

The sign of Leser-Trelat is an eruptive appearance or increase in the number of seborrheic keratoses. It is usually associated with underlying internal malignancy, especially gastric adenocarcinoma. Herein, we report a case of Leser-Trelat syndrome that preceeded the diagnosis of both prostate adenocarcinoma and cutaneous squamous cell carcinoma. Since Leser-Trelat syndrome may be the presenting sign of a new or recurrent tumour, we would like to emphasize the importance of the possibility of an underlying neoplasm and suggest appropriate screening.

Leser–Trélat syndrome in malignant mesothelioma and pulmonary adenocarcinoma: is the EGFR pathway part of the syndrome?

The syndrome of Leser–Trélat (LT) is characterized by the sudden appearance of multiple seborrhoeic keratoses (SKs) in association with internal occult malignancy. Usually, the syndrome has been associated with adenocarcinoma, most frequently of the gastrointestinal tract and breast. The pathogenesis is unclear but might be explained by circulating tumor-associated growth factors. We present two thoracic malignancies associated with LT: adenocarcinoma of the lung (ACL) and pleural malignant mesothelioma (MM). Both malignant tumors expressed high levels of epidermal growth factor receptors (EGFR) detected by immunohistochemistry (IHC), with membranous staining on the majority of malignant cells corresponding to maximum IHC scores of 290 and 300, respectively, for the MM and the ACL. SKs revealed a universal membranous staining throughout the entire epithelium with no difference in EGFR expression between the two cases and two controls with no malignant history. By fluorescence in situ hybridization, no amplification of the EGFR gene in malignant tumors as well as in SK lesions was observed. Further investigations are needed to see whether tumor-associated EGFR ligands/EGFR autocrine loops in malignant cells expressing high levels of EGFR protein on the surface might play a role for the development of SKs, as well as for the growth of malignant tumors in LT.

Leser–Trélat sign: current observations

Leser–Trelat sign is a cutaneous manifestation that presents with rapid onset of multiple seborrheic keratoses on the trunk and extremities. In the majority of cases, seborrheic keratoses increase in number within short periods (usually within 6 months). Seborrheic keratoses are commonly seen in elderly people; however, Leser–Trelat sign is important because it may be a clue to the discovery of occult internal malignancies. Adenocarcinomas involving the stomach, intestine and breast are commonly associated with Leser–Trelat sign, however, hematological malignancies have also been detected. Several reports have shown that Leser–Trelat sign is associated with benign neoplasms. Although the etiology of Leser–Trelat sign is largely unknown, several speculations have been proposed. EGF and TGF-α are derived from the original tumor cells, while EGF-receptor (EGF-R) is expressed on the epidermis. This suggests that the development of seborrheic keratoses may be accelerated via EGF-R-mediated signaling pathways. ...

Eruptive seborrheic keratoses associated with adalimumab use

Seborrheic keratoses are common, benign cutaneous growths, however in rare situations they can acutely erupt in large numbers. Eruptive seborrheic keratoses can be associated with internal malignancy (sign of Leser-Trelat), but may also appear in conjunction with inflammatory dermatoses and adverse drug reactions. A 71-year-old Caucasian man presented with acute onset of a pruritic, burning papular erythematous rash on his chest, upper extremities and lower extremities after a routine adalimumab injection for rheumatoid arthritis. Two skin biopsies obtained showed findings diagnostic of seborrheic keratoses. Spontaneous resolution of the diffuse eruptive seborrheic keratoses was achieved within 3 months of discontinuing adalimumab therapy. We believe the development of eruptive seborrheic keratoses due to adalimumab therapy is rare, and because our patient responded promptly to discontinuation of the drug we suggest this should be the preferred course of action in future cases.

Pigmented Seborrheic Keratosis (Melanoacanthoma) of Nipple A case report with review of literature

Seborrheic Keratosis is a benign skin lesion which develops from the proliferation of keratinocytes of the epidermis. There are very few case reports of seborrheic keratosis occurring over the nipple and areola. Pigmented seborrheic keratosis can be easily mistaken for malignant melanoma. Its occurrence may be associated with internal malignany (Leser-Trelat sign). We report a case of pigmented seborrheic keratosis of nipple in a 43 year old lady, its associations and differential diagnosis. Key words: pigmented nodule, seborrheic keratosis, nipple, areola

Uterine leiomyosarcoma and Leser-Trélat sign

In December, 2010, a 79-year-old nulliparous woman presented to our outpatient clinic for investigation of a 6 month history of postmenopausal bleeding. She had experienced menopause at the age of 46 years and had never used hormonal replacement therapy. She had had surgery for a gastric ulcer when she was 39 years old and had been taking anti-hypertensives since 1990. She reported that she had had a few, small (<1 cm) warty lesions on her body for 20 years and that a rapid increase in their size and number had coincided with the postmenopausal bleeding. On examination, she had many seborrhoeic keratoses on her trunk and face consistent with the Leser-Trelat sign. Digital vaginal examination showed a 9 cm mobile uterus with no palpable adnexal masses. An ultrasound of the vagina showed an intracavitary lesion with myometrial invasion, highly suggestive of endometrial cancer. MRI of the pelvis showed a 5 cm, irregular, heterogeneous tumour of the uterine body that bulged into the uterine cavity. There was no lymphadenopathy. Full blood count, urea and electrolytes, liver function tests, radiography of the chest, and sonography of the abdomen were all normal. Pathological examination of a biopsy sample of the endometrium led to a diagnosis of leiomyosarcoma, and we did a total abdominal hyster ectomy and bilateral salpingo-oophorectomy. Gross examination of the specimen showed a 6·5 × 4 cm irregular, friable, infi ltrating tumour, which was tanwhite on section. Histological examination showed irregular fascicles of spindled cells with moderate anisonucleosis and irregular nucleoli. Mitotic index was greater than 10 per high powered fi eld and deep infi ltration reached more than four-fi fths of the uterine wall. The tumour was stage IC according to the Federation of Gynecology and Obstetrics (FIGO) staging Lancet 2013; 381: 88