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Matwiejuk M, Myśliwiec H, Chabowski A, Flisiak I. An Overview of Growth Factors as the Potential Link between Psoriasis and Metabolic Syndrome. J Clin Med 2023; 13:109. [PMID: 38202116 PMCID: PMC10780265 DOI: 10.3390/jcm13010109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
Psoriasis is a chronic, complex, and immunologically mediated systemic disease that not only affects the skin, but also the joints and nails. It may coexist with various other disorders, such as depression, psoriatic arthritis, cardiovascular diseases, diabetes mellitus, and metabolic syndrome. In particular, the potential link between psoriasis and metabolic syndrome is an issue worthy of attention. The dysregulation of growth factors could potentially contribute to the disturbances of keratinocyte proliferation, inflammation, and itch severity. However, the pathophysiology of psoriasis and its comorbidities, such as metabolic syndrome, remains incompletely elucidated. Growth factors and their abnormal metabolism may be a potential link connecting these conditions. Overall, the objective of this review is to analyze the role of growth factor disturbances in both psoriasis and metabolic syndrome.
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Affiliation(s)
- Mateusz Matwiejuk
- Department of Dermatology and Venereology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Hanna Myśliwiec
- Department of Dermatology and Venereology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, 15-089 Bialystok, Poland
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2
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Wong C, Patel S, LaPorta A, Towne F, Gubler KD, Bartone P, Ryznar R. Correlation analysis of salivary cytokines and hormones with resiliency. J Trauma Acute Care Surg 2023; 95:664-671. [PMID: 37332103 PMCID: PMC10637304 DOI: 10.1097/ta.0000000000004026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Frequent exposure to acute stress increases risk of suicide, posttraumatic stress disorder, and other stress-related disorders. Neuroendocrine and immunologic dysregulation associated with stress may underlie predispositions to psychological disorders and inflammatory disease processes in individuals, such as first-responders and other healthcare professionals, who function in high stress situations. The Hardiness Resilience Gauge (HRG) can be used to psychometrically measure resilience, a psychological modifier of the stress response. Using the HRG alongside salivary biomarker profiling, may help to identify low resilience phenotypes and allow mitigation and early therapeutic interventions. There is a paucity of knowledge regarding biomarkers of resilience. This study aims to evaluate the relationship between factors of resilience with salivary biomarker levels and fluctuations during and following acute stress. METHODS Sixty-three first responders underwent a standardized stress-inducing training exercise, providing salivary samples before (prestress), immediately after (post-stress), and 1 hour after the event (recovery). The HRG was administered before (initial) and after (final) the event. Multiplex ELISA panels quantified 42 cytokines and 6 hormones from the samples, which were analyzed for relationships to psychometric factors of resilience measured by the HRG. RESULTS Several biomarkers correlated with psychological resilience following the acute stress event. The HRG scores correlated ( p < 0.05) with a select set of biomarkers with moderate-to-strong correlations (|r| > 0.3). These included EGF, GROα, PDGFAA, TGFα, VEGFA, interleukin (IL)1Ra, TNFα, IL18, cortisol, FGF2, IL13, IL15, and IL6. Interestingly, fluctuations of EGF, GROα, and PDGFAA in post-stress compared with recovery were positively correlated with factors of resilience, which were negatively correlated from the pre-stress to post-stress period. CONCLUSION This exploratory analysis discovered a small subset of salivary biomarkers that are significantly correlated with acute stress and resilience. Further investigation of their specific roles in acute stress and associations with resiliency phenotypes is warranted.
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3
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Kunovsky L, Dite P, Brezinova E, Sedlakova L, Trna J, Jabandziev P. Skin manifestations of pancreatic diseases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:353-358. [PMID: 35938387 DOI: 10.5507/bp.2022.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022] Open
Abstract
Although symptoms of pancreatic diseases such as pancreatitis, acute and chronic and, carcinoma of the pancreas are mainly gastrointestinal in nature, the extra-pancreatic symptoms are also important. These include skin symptoms, such as pancreatic panniculitis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema, cutaneous signs of hemorrhage, as in persons with severe acute pancreatitis, or the finding of cutaneous metastases of pancreatic carcinoma, which may be a sign of advanced disease. The pancreas is therefore one of those organs for which diagnosis and therapy are often multidisciplinary. In this review article, we summarize current knowledge of the possible skin manifestations of pancreatic disorders.
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Affiliation(s)
- Lumir Kunovsky
- Department of Surgery, University Hospital Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic.,2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Dite
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Czech Republic.,Faculty of Medicine, University of Ostrava, Czech Republic
| | - Eva Brezinova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1st Department of Dermatovenerology, St. Anne's University Hospital, Brno, Czech Republic
| | - Libuse Sedlakova
- Department of Dermatology, Military Hospital Brno, Czech Republic
| | - Jan Trna
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Jabandziev
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Pediatrics, University Hospital Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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4
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Schmidt MF, Schaller M, Schmitt LC. [Hyperplasia-associated cutaneous paraneoplasia]. Hautarzt 2021; 72:295-298. [PMID: 33660024 DOI: 10.1007/s00105-021-04777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hyperplasia-associated cutaneous paraneoplasia is an important differential diagnosis in everyday clinical practice. An early diagnosis of the underlying tumor disease can significantly improve the patient's prognosis. PATHOGENESIS Hyperplasia is probably mainly cytokine-mediated. The primary tumor and/or the metastases release growth factors and transcription factors which, via epidermal growth factors, lead to hyperproliferation of keratinocytes. ACANTHOSIS NIGRICANS MALIGNA Symmetrical mainly intertriginous hyperpigmentation with partially verrucous hyperplasia and lichenification mostly in association with gastric adenocarcinoma. Special forms are florid cutaneous papillomatosis and tripe palms. Pseudoacanthosis nigricans is to be distinguished (metabolic and hormonal disorders). LESER-TRéLAT SYNDROME: Eruptive occurrence of seborrheic keratosis associated with visceral tumors. ACROKERATOSIS BAZEX Erythema and scaling initially at the bridge of the nose, ear helix and acra with later spread, associated with tumors of the upper aerodigestive system. It should be clinically differentiated from psoriasis. THERAPY The treatment of the primary tumor is decisive, which also leads to a decrease of cutaneous symptoms. Reappreance suggests tumor recurrence.
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Affiliation(s)
- Morna F Schmidt
- Klinik für Dermatologie und Allergologie, Hautklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Martin Schaller
- Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Laurenz C Schmitt
- Klinik für Dermatologie und Allergologie, Hautklinik, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
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5
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Chronic Systemic Inflammatory Skin Disease as a Risk Factor for Cardiovascular Disease. Curr Probl Cardiol 2021; 46:100799. [PMID: 33607473 DOI: 10.1016/j.cpcardiol.2021.100799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 01/10/2021] [Indexed: 11/24/2022]
Abstract
Chronic systemic skin disease and cardiovascular disease are multisystem disorders which have been associated with each other for centuries. Recent research has strengthened this association, particularly in systemic inflammatory disease. Here we explore the current literature on psoriasis, hidradenitis suppurativa, lupus erythematosus, acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. Psoriasis is a chronic inflammatory disorder that has been labeled as a risk-modifier for hyperlipidemia and coronary artery disease by the American College of Cardiology ACC lipid guidelines. Cardiovascular disease is also found at a significantly higher rate in patients with hidradenitis suppurativa and lupus erythematosus. Some associations have even been noted between cardiovascular disease and acanthosis nigricans, atopic dermatitis, and bullous pemphigoid. While many of these associations have been attributed to a shared underlying disease process such as chronic systemic inflammation and shared underlying risk factors, these dermatologic manifestations can help to identify patients at higher risk for cardiovascular disease.
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6
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Miulescu R, Balaban DV, Sandru F, Jinga M. Cutaneous Manifestations in Pancreatic Diseases-A Review. J Clin Med 2020; 9:E2611. [PMID: 32806580 PMCID: PMC7464368 DOI: 10.3390/jcm9082611] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.
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Affiliation(s)
- Raluca Miulescu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
| | - Daniel Vasile Balaban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
| | - Mariana Jinga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
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7
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Alter M, Mengoni M, Gaffal E. Hautveränderungen bei internen Neoplasien. J Dtsch Dermatol Ges 2020; 18:456-471. [DOI: 10.1111/ddg.14093_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/08/2020] [Indexed: 12/01/2022]
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8
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Alter M, Mengoni M, Gaffal E. Cutaneous manifestations of internal malignancy. J Dtsch Dermatol Ges 2020; 18:456-469. [PMID: 32311823 DOI: 10.1111/ddg.14093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/08/2020] [Indexed: 12/13/2022]
Abstract
Skin lesions associated with internal malignancy may present as cutaneous metastases or as typical lesions occurring in the context of certain cancer-associated genetic syndromes. Paraneoplastic syndromes, on the other hand, are only indirectly associated with an underlying malignancy and are not malignant per se. Historically, a distinction has been made between "obligate" and "facultative" paraneoplastic disorders, depending on the likelihood with which they are potentially associated with malignancy. In addition, there are nonspecific cutaneous manifestations that are only rarely associated with an underlying malignancy. Another possible classification is based on the pathophysiological mechanisms underlying the cutaneous lesions. In everyday practice, it is essential that dermatologists recognize potentially cancer-associated dermatoses, as this will frequently contribute to the initial diagnosis of an underlying neoplasm.
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Affiliation(s)
- Mareike Alter
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Miriam Mengoni
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Evelyn Gaffal
- Department of Dermatology, University Medical Center, Magdeburg, Germany
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9
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Alkeswani A, Pierce E, Elmets CA. Idiopathic extensive acanthosis nigricans with a variant of the epidermal growth factor receptor. JAAD Case Rep 2020; 6:79-82. [PMID: 31970282 PMCID: PMC6965189 DOI: 10.1016/j.jdcr.2019.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Amena Alkeswani
- School of Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Evelina Pierce
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
| | - Craig A Elmets
- Department of Dermatology, University of Alabama Birmingham, Birmingham, Alabama
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10
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Keller JJ, Fett NM, Morrison LH. Dermatology in the Diagnosis of Noncutaneous Malignancy. Dermatol Clin 2019; 37:537-544. [DOI: 10.1016/j.det.2019.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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11
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Leon L, Shuen AY, Vizirakis M, McCord C. Papillomatosis of the hard palate. J Am Dent Assoc 2019; 150:788-793. [DOI: 10.1016/j.adaj.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/09/2018] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
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12
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Arellano J, Iglesias P, Suarez C, Corredoira Y, Schnettler K. Malignant acanthosis nigricans as a paraneoplastic manifestation of metastatic breast cancer. Int J Womens Dermatol 2019; 5:183-186. [PMID: 31360756 PMCID: PMC6637086 DOI: 10.1016/j.ijwd.2019.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/01/2019] [Accepted: 03/13/2019] [Indexed: 10/30/2022] Open
Abstract
Malignant acanthosis nigricans is a rare paraneoplastic syndrome, usually associated with a gastric adenocarcinoma and less frequently with other neoplasms. In general, its appearance indicates a poor prognosis with a survival of < 2 years. We describe the case of a 40-year-old patient who presented with generalized cutaneous thickening that had a velvety appearance, was rapidly progressing, and involved right axillary adenopathy. Skin and nipple biopsy yielded results consistent with acanthosis nigricans, and palpable adenopathy biopsy results were compatible with mammary adenocarcinoma (human epidermal growth factor receptor 2 positive and estrogen and progesterone receptor negative) without a detectable primary tumor. This case of malignant acanthosis nigricans is presented because of the importance of its early recognition as a paraneoplastic syndrome and its relation with mammary adenocarcinoma, an association infrequently reported in the literature.
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Affiliation(s)
- Javier Arellano
- Department of Dermatology, University of Chile, Santiago, Chile.,Department of Dermatology, Hospital Clínico San Borja, Arriarán, Chile
| | - Pamela Iglesias
- Department of Dermatology, University of Chile, Santiago, Chile
| | - Claudia Suarez
- Department of Dermatology, University of Chile, Santiago, Chile
| | - Yamile Corredoira
- Department of Pathology, University of Chile, Santiago, Chile.,Department of Pathology, Hospital Clínico San Borja, Arriarán, Chile
| | - Katty Schnettler
- Department of Pathology, Hospital Clínico San Borja, Arriarán, Chile
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13
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Chatzopoulou D, Triantafyllou T, Tsamis D, Chrysikos D, Kalles V, Zografos G, Theodorou D. Case presentation of acanthosis nigricans diagnosed with gastric adenocarcinoma. ANZ J Surg 2019; 90:182-184. [PMID: 30836438 DOI: 10.1111/ans.15052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/27/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Despoina Chatzopoulou
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Tania Triantafyllou
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tsamis
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenis Chrysikos
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Kalles
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Zografos
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Theodorou
- Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, 'Hippokration' General Hospital of Athens, National and Kapodistrian University of Athens, Athens, Greece
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14
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Moreno-Artero E, Querol E, Ivars M, Sola I, Pío R, España A. Assessment of EGF receptor ligand expression in gastric carcinoma and in lesional skin of paraneoplastic acanthosis nigricans: a case report. J Eur Acad Dermatol Venereol 2016; 31:e301-e302. [PMID: 27987313 DOI: 10.1111/jdv.14087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Moreno-Artero
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
| | - E Querol
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
| | - M Ivars
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
| | - I Sola
- Department of Pathology, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - R Pío
- Program in Solid Tumors and Biomarkers - CIMA (Center for Applied Medical Research), University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - A España
- Department of Dermatology, School of Medicine, University Clinic of Navarra, University of Navarra, IdiSNA, Navarra Institute for Health Research, PO Box 4209, Pamplona, Navarra, Spain
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15
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Ferraz de Campos FP, Narvaez MRA, Reis PVS, Gomes ACM, Paraskevopoulos DKDS, Santana F, Fugita OEH. Acanthosis Nigricans associated with clear-cell renal cell carcinoma. AUTOPSY AND CASE REPORTS 2016; 6:33-40. [PMID: 27284539 PMCID: PMC4880432 DOI: 10.4322/acr.2016.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/31/2016] [Indexed: 12/29/2022] Open
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.
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Affiliation(s)
| | | | | | | | | | - Frederico Santana
- Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil
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16
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Abstract
The skin is often the herald of an underlying systemic illness, and gastrointestinal malignancies can present in numerous ways in the skin. Paraneoplastic phenomenon, such as acanthosis nigricans and tripe palm, may be the first indicator of a gastrointestinal malignancy. In addition, gastrointestinal cancers can metastasize to the skin, as described in the well-known Sister Mary Joseph's nodule. Inflammatory systemic conditions such as dermatomyositis and multicentric reticulohistiocytosis can be associated with underlying malignancy. Finally, in numerous genetic syndromes with underlying malignancies, such as Muir-Torre, recognition of the skin signs leads to early diagnosis and screening.
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17
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Malignant Acanthosis Nigricans, Florid Cutaneous and Mucosal Papillomatosis and Tripe Palms in a man with gastric adenocarcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Vilas-Sueiro A, Suárez-Amor Ó, Monteagudo B, de Las Heras C. Malignant acanthosis nigricans, florid cutaneous and mucosal papillomatosis, and tripe palms in a man with gastric adenocarcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2014; 106:438-9. [PMID: 25544016 DOI: 10.1016/j.ad.2014.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- A Vilas-Sueiro
- Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, España.
| | - Ó Suárez-Amor
- Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, España
| | - B Monteagudo
- Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, España
| | - C de Las Heras
- Servicio de Dermatología, Complejo Hospitalario Universitario de Ferrol, Área Sanitaria de Ferrol, SERGAS, Ferrol, A Coruña, España
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Kubicka-Wołkowska J, Dębska-Szmich S, Lisik-Habib M, Noweta M, Potemski P. Malignant acanthosis nigricans associated with prostate cancer: a case report. BMC Urol 2014; 14:88. [PMID: 25399333 PMCID: PMC4239373 DOI: 10.1186/1471-2490-14-88] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/29/2014] [Indexed: 12/17/2022] Open
Abstract
Background Acanthosis nigricans is characterized by hyperpigmentation and hyperkeratosis of the skin or mucous membranes. Its malignant form is associated with internal neoplasms, especially gastric adenocarcinoma (55–61%). Coexistence with prostate cancer is uncommon. In the paraneoplastic type of this dermatosis, the skin and mucous lesions are characteristically of more sudden onset and more severe than those in the benign form. The efficacy of various treatment strategies remains disappointing. Case presentation We here report a case of 66-year-old Caucasian patient with metastatic prostate cancer and a mild form of acanthosis nigricans that preceded the diagnosis of malignancy and resolved with chemotherapy in parallel with the prostate cancer. The dermatosis recurred when the prostate cancer progressed. Conclusion Concurrent acanthosis nigricans and prostate cancer is rare, and few such cases have been reported. Anti-tumor therapy occasionally results in regression of this dermatosis. Underlying malignant disease should be suspected in individuals with elderly-onset of acanthosis nigricans.
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20
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Chakraborty PP, Datta S, Mandal SK, Kumar M. Tripe palm: a cutaneous manifestation of gastric carcinoma. BMJ Case Rep 2014; 2014:bcr-2014-206004. [PMID: 25323284 DOI: 10.1136/bcr-2014-206004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Case 1: A 43-year-old farmer attended our clinic with increasing fatigability, nausea, loss of appetite, loss of weight, postprandial fullness along with thyroid-stimulating hormone value of 0.4 mIU/L and anaemia without any history of cough, chest pain, haemoptysis, osmotic symptoms, haematemesis or malena. The patient received albendazole and iron preparations before attending our clinic. Case 2: A 51-year-old woman, a known patient with type 2 diabetes for the past 8 years, on gliclazide and metformin (2 g), with unaltered liver function test and renal function test, presented with symptoms similar to case 1 of upper gastrointestinal features along with a history of weight loss (about 6 kg) over the past 3 months. Metformin was withdrawn by her primary care physician but her symptoms persisted. A velvety appearance with pigmentation on the palms of the hands was found in both cases. Endoscopy revealed an irregular mass in the stomach. Subsequently, both patients were diagnosed to have gastric adenocarcinoma.
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Affiliation(s)
| | - Saumik Datta
- Department of Endocrinology, IPGME & R, Kolkata, West Bengal, India
| | - Sanjay Kumar Mandal
- Department of Internal Medicine, Medical College, Kolkata, West Bengal, India
| | - Manoj Kumar
- Department of Endocrinology, IPGME & R, Kolkata, West Bengal, India
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Malignant acanthosis nigricans, florid cutaneous papillomatosis and tripe palms syndrome associated with gastric adenocarcinoma. Postepy Dermatol Alergol 2014; 31:56-8. [PMID: 24683401 PMCID: PMC3952059 DOI: 10.5114/pdia.2014.40663] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 08/23/2013] [Accepted: 09/18/2013] [Indexed: 01/14/2023] Open
Abstract
Malignant acanthosis nigricans is a rare paraneoplastic skin syndrome mostly associated with gastric adenocarcinoma. Florid cutaneous papillomatosis and tripe palms syndrome are considered to be abortive clinical variants of acanthosis nigricans. Clinical manifestations include pruritic, hyperkeratotic and hyperpigmented plaques with a subsequent formation of velvety papillomas in the involved areas. This case report describes an unusual case of the patient diagnosed with a combination of malignant acanthosis nigricans, florid cutaneous papillomatosis and tripe palms syndrome associated with gastric adenocarcinoma.
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Chu HW, Li JM, Chen GF, Ma JY. Oral malignant acanthosis nigricans associated with endometrial adenocarcinoma. Int J Oral Sci 2014; 6:247-9. [PMID: 24406633 PMCID: PMC5153582 DOI: 10.1038/ijos.2014.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 11/09/2022] Open
Abstract
We report a 59-year-old patient with malignant acanthosis nigricans associated with metastasis of endometrial carcinoma. The patient presented papillomatosis lesions that appeared to be benign on multiple skins of body folds, particularly on lips. The lesions in lips and axilla had histological characteristic appearances of acanthosis nigricans, while the masses in abdomen and pelvis were metastasis endometrial adenocarcinoma. The article highlights the importance of biopsy and histopathological diagnosis in presumed benign lesions and the role of doctors in screening for body internal tumors.
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Affiliation(s)
- Han-Wen Chu
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing-Min Li
- Hangzhou Stomatological Hospital, Hangzhou, China
| | - Guan-Fu Chen
- Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing-Yuan Ma
- Department of Oral Medicine, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Wu J, Tong S, Zhan Z, Zhang J, Chen C, Hu S, Wang R. TGF-α gene variations and increased susceptibility of gastric cancer in an Eastern Chinese Han population. Biomarkers 2013; 19:9-15. [PMID: 24237184 DOI: 10.3109/1354750x.2013.859736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Transforming growth factor-alpha (TGF-α) correlates with deep invasion, advanced stage and poor prognosis in gastric cancer. Genetic variants in the 3' untranslated region (UTR) of TGF-α gene may influence the stability and post-transcriptional regulation of mRNA and contribute to gastric cancer predisposition. To test this hypothesis, we genotyped five polymorphisms in 3'UTR (rs3771527, rs503314, rs473698, rs3732253 and rs538118) and one in 3' near region (rs11466306) of the TGF-α gene by polymerase chain reaction-ligation detection reaction methods (PCR-LDR). We found that GA/AA genotype of rs11466306 in the 3' near gene could increase the risk of overall gastric cancer (adjusted OR = 1.499, 95%CI: 1.101-2.041), compared to the wild homozygous GG genotype. Meanwhile, the risk effect was more obvious in the intestinal gastric cancer and gastric noncardia cancer (adjusted OR = 1.682, 95%CI: 1.188-2.380; adjusted OR = 1.495, 95%CI: 1.072-2.086, respectively), but not for the diffuse type and gastric cardia cancer (p > 0.05). CT/TT genotype for rs3732253 in the 3' UTR was associated with increased risk of intestinal gastric cancer (adjusted OR = 1.464, 95%CI: 1.036-2.069), compared to their wild homozygous genotypes. These findings indicate that potentially functional TGF-α gene variant may contribute to the risk of intestinal gastric cancer and/or gastric noncardia cancer and could be used as molecular markers for detecting intestinal gastric cancer and/or gastric noncardia cancer in Chinese Han population.
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Affiliation(s)
- Juan Wu
- Discipline of Chinese and Western Integrative Medicine, Nanjing University of Chinese Medicine , Nanjing , China
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Zhang N, Qian Y, Feng AP. Acanthosis nigricans, tripe palms, and sign of Leser-Trélat in a patient with gastric adenocarcinoma: case report and literature review in China. Int J Dermatol 2013; 54:338-42. [PMID: 23675743 DOI: 10.1111/ijd.12034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Na Zhang
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China, 430022
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26
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Schulmann K, Strate K, Pox CP, Wieland U, Kreuter A. Paraneoplastic Acanthosis Nigricans With Cutaneous and Mucosal Papillomatosis Preceding Recurrence of a Gastric Adenocarcinoma. J Clin Oncol 2012; 30:e325-6. [DOI: 10.1200/jco.2012.42.5454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Katharina Strate
- Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Christian P. Pox
- Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
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27
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Jakubovic BD, Sawires HF, Adam DN. Occult cause of paraneoplastic acanthosis nigricans in a patient with known breast dcis: case and review. ACTA ACUST UNITED AC 2012; 19:e299-302. [PMID: 22876161 DOI: 10.3747/co.19.997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Paraneoplastic acanthosis nigricans (pan) is an infrequently encountered cutaneous manifestation of internal malignancy. Here, we describe a case of pan in the setting of a known breast ductal carcinoma in situ, which, to our knowledge, had not been described in association with pan. As a result, thorough investigation was undertaken to search for another concurrent neoplasm that would better explain the development of pan. In so doing, we identified a coexisting metastatic cholangiocarcinoma. We thus conclude that when pan is observed in an uncommon association with a known malignancy, further investigation should be undertaken to explore whether a more likely occult culprit exists.
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Affiliation(s)
- B D Jakubovic
- Faculty of Medicine, University of Toronto, Toronto, ON
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Abu-Safieh Y, Khelfa S. Acanthosis nigricans: A presentation of gastric adenocarcinoma. Arab J Gastroenterol 2011; 12:156-7. [PMID: 22055596 DOI: 10.1016/j.ajg.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 04/01/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Yasser Abu-Safieh
- Specialised Arab Hospital, Annajah University, Nablus, Occupied Palestinian Territory.
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Lee SS, Jung NJ, Im M, Lee Y, Seo YJ, Lee JH. Acral-type Malignant Acanthosis Nigricans Associated with Gastric Adenocarcinoma. Ann Dermatol 2011; 23:S208-10. [PMID: 22148052 PMCID: PMC3229067 DOI: 10.5021/ad.2011.23.s2.s208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 05/04/2011] [Accepted: 05/06/2011] [Indexed: 11/20/2022] Open
Abstract
Acanthosis nigricans is a symmetric eruption characterized by the presence of a hyperpigmented, velvety cutaneous thickening, that can develop on any part of the body, but characteristically affects the flexural areas of the body. The velvety hyperkeratotic lesions can be located on the dorsum of the hands and feet in dark-skinned people in the form of a variant of acanthosis nigricans called as acral acanthotic anomaly or acral type acanthosis nigricans. Although acanthosis nigricans is associated with malignant tumors, particularly gastric carcinoma, acral type acanthosis nigricans has never been reported to be associated with gastric adenocarcinoma. In our present study, we describe a case of 58-year-old man with acral type acanthosis nigricans and its association with carcinoma of the stomach; a marked improvement was seen in the skin condition of the patient with chemotherapy.
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Affiliation(s)
- Sang-Sin Lee
- Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea
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30
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Chrysomali E, Piperi E, Sklavounou-Andrikopoulou A. Oral acanthosis nigricans in chronic hepatitis B with a 21-year follow up. J Dermatol 2011; 38:1172-6. [PMID: 21966946 DOI: 10.1111/j.1346-8138.2011.01252.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acanthosis nigricans is a rare mucocutaneous disorder of unknown etiology that manifests as hyperpigmented velvety plaques, most often on intertriginous areas such as the neck and axillae as well as on mucosal sites such as the oral cavity. The disorder presents either as a paraneoplastic manifestation of an underlying malignancy, especially gastrointestinal adenocarcinomas or in association with obesity, administration of drugs or endocrinopathies, most commonly insulin-resistant diabetes mellitus. In the present article, a case of acanthosis nigricans with oral and cutaneous manifestations in a male patient with chronic hepatitis B infection is described. To the best of our knowledge, this is the first case of benign oral acanthosis nigricans associated with chronic hepatitis B.
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Affiliation(s)
- Evanthia Chrysomali
- Department of Oral Pathology and Medicine, Dental School, National and Kapodistrian University of Athens, Athens, Greece.
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31
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Ehst BD, Minzer-Conzetti K, Swerdlin A, Devere TS. Cutaneous manifestations of internal malignancy. Curr Probl Surg 2010; 47:384-445. [PMID: 20363406 DOI: 10.1067/j.cpsurg.2010.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Scully C, Barrett W, Gilkes J, Rees M, Sarner M, Southcott R. Oral acanthosis nigricans, the sign of Leser-Trélat and cholangiocarcinoma. Br J Dermatol 2008. [DOI: 10.1111/j.1365-2133.2001.04393.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Florid cutaneous papillomatosis with acanthosis nigricans in a patient with carcinomas of the lung and prostate. J Am Acad Dermatol 2007; 57:907-8. [PMID: 17939948 DOI: 10.1016/j.jaad.2006.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 02/02/2006] [Accepted: 02/06/2006] [Indexed: 11/23/2022]
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35
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Sinha S, Schwartz RA. Juvenile acanthosis nigricans. J Am Acad Dermatol 2007; 57:502-8. [PMID: 17592743 DOI: 10.1016/j.jaad.2006.08.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 06/20/2006] [Accepted: 08/03/2006] [Indexed: 12/16/2022]
Abstract
Acanthosis nigricans is a velvety thickening of the epidermis that primarily affects the axillae, posterior neck fold, flexor skin surfaces, and umbilicus, and infrequently is diffuse with involvement of the mucosal surfaces. It is increasingly seen in children and adolescents who are obese, and can serve as a cutaneous marker of insulin resistance and malignancy. Although malignancy-associated acanthosis nigricans is rare in the pediatric population, one need be concerned about its association with certain pediatric syndromes. More importantly, insulin resistance itself can also represent a threat to life. We review this important disorder.
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Affiliation(s)
- Smeeta Sinha
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103, USA
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Muñoz Díaz F, García Carrasco C, Monge Romero MI, de Dios Arrebola García J, Soria Monge A. Acantosis nigricans como manifestación inicial paraneoplásica de adenocarcinoma gástrico. GASTROENTEROLOGIA Y HEPATOLOGIA 2007; 30:15-8. [PMID: 17266876 DOI: 10.1157/13097444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We report the case of a 29-year-old man with cutaneous hyperpigmentation located especially in intertriginous areas. The lesions were velvety, rugose and highly pruriginous. The patient was diagnosed with acanthosis nigricans. Initial treatment with topical corticosteroids and oral antihistamines was unsuccessful and, due to suspicion of a paraneoplastic cutaneous syndrome, gastroscopy with sampling for biopsy and abdominal CT were carried out, revealing the existence of an infiltrating gastric adenocarcinoma and underlying adenopathies. The patient underwent total gastrectomy extended to spleen and pancreatic tail and D2 lymph node dissection. Treatment was completed by radiotherapy and chemotherapy to treat lymph node involvement.
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Affiliation(s)
- Fernando Muñoz Díaz
- Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Badajoz, Spain.
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37
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Kebria MM, Belinson J, Kim R, Mekhail TM. Malignant acanthosis nigricans, tripe palms and the sign of Leser-Tre'lat, a hint to the diagnosis of early stage ovarian cancer: a case report and review of the literature. Gynecol Oncol 2006; 101:353-5. [PMID: 16443260 DOI: 10.1016/j.ygyno.2005.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 12/15/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malignant acanthosis nigricans is a mucocutaneous eruption associated with internal malignancies. Tripe palms refers to a characteristic velvety thickening of the palms, with exaggeration of normal skin markings. The sign of Leser-Tre'lat is the presence of multiple seborrheic keratoses and scattered skin tags caused by a malignancy. We are reporting the first case of ovarian cancer in association with three coexisting cutaneous paraneoplastic dermatosis. CASE A 52-year-old female presented with skin manifestation consistent with MAN, TP and the sign of Leser-Tre'lat. Patient underwent extensive work up and was discovered to have stage I, high grade adenocarcinoma of the ovary. Skin manifestations gradually recovered after initiation of chemotherapy. CONCLUSION The presence of acanthosis nigricans in conjunction with tripe palms and the sign of Leser-Tre'lat are highly suggestive of an internal malignancy and necessitate an extensive investigation in order to discover the underlying malignancy.
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Affiliation(s)
- Mehdi M Kebria
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Badawi RA, Birns J, Watson T, Kalra L. Growth factors and their relationship to neoplastic and paraneoplastic disease. Eur J Intern Med 2005; 16:83-94. [PMID: 15833673 DOI: 10.1016/j.ejim.2004.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 09/30/2004] [Accepted: 10/05/2004] [Indexed: 12/15/2022]
Abstract
Growth factors are extracellular signaling molecules that act in an autocrine and paracrine fashion to regulate growth, proliferation, differentiation, and survival of cells. Dysregulation of the growth factor networks is intimately related to the molecular pathogenesis of neoplastic and paraneoplastic disease. Increasing knowledge of the molecular mechanisms underlying growth factors and their actions on cell cycling, cell division, and cell death is shedding light on new therapeutic avenues for molecular targeting of tumors. Epidermal growth factor and vascular endothelial growth factor both offer examples of how growth factor biology and its relationship to cancer can be harnessed to create effective clinical therapeutic tools such as monoclonal antibodies. This approach heralds a future in which rational molecular oncological therapy may increasingly become the norm.
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Affiliation(s)
- R A Badawi
- Department of Medicine, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
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Espinoza LA, Tone LG, Neto JB, Costa RS, Wang QJ, Ballejo G. Enhanced TGFalpha-EGFR expression and P53 gene alterations contributes to gastric tumors aggressiveness. Cancer Lett 2004; 212:33-41. [PMID: 15246559 DOI: 10.1016/j.canlet.2004.03.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2003] [Revised: 03/22/2004] [Accepted: 03/23/2004] [Indexed: 01/19/2023]
Abstract
We determined whether alterations in the expression of p53, p16(INK4) and p21(WAF1/CIP1) influence the invasiveness of a subset of gastric adenocarcinomas co-expressing TGFalpha and EGFR. Immunopositivity for TGFalpha-EGFR (26%) was observed in both early and advanced adenocarcinomas, and 88% of these showed immunoreactivity for p53. SSCP analysis revealed that in 81% of these tumors the p53 gene was mutated in exons 5-8. The intensity of p53 immunoreactivity was significantly higher (P < 0.013) in deeply invasive tumors. p16(INK4) and p21(WAF1/CIP1) immunoreactivity was detected in 93 and 76% of the samples co-expressing TGFalpha-EGFR but the levels were not correlated with those of p53 and other clinico-pathological parameters. We conclude that gastric adenocarcinomas potentially dependent upon the TGFalpha-EGFR autocrine loop for growing exhibit increased aggressiveness in the presence of aberrant p53.
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Affiliation(s)
- Luis A Espinoza
- Department of Genetics, School of Medicine of Ribeirão Preto, Universidade de Sao Paulo, Ribeirão Preto, SP 1404900, Brazil.
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Abstract
Cutaneous paraneoplastic syndromes are a group of noncancerous dermatoses associated with internal malignancy. Their recognition can facilitate detection and timely treatment of underlying cancer. More than 30 such disorders have been identified in the human scientific literature, whereas only a few are described in veterinary medicine. This may reflect a lower incidence in animals than in people or may be the result of failure to recognize an association between certain skin lesions and neoplasia. Establishing a relationship between a cutaneous disorder and neoplasia can be difficult unless the skin lesions are rare and almost always associated with a particular tumour type, as is the case for most recognized veterinary paraneoplastic dermatoses. Among these are feline paraneoplastic alopecia, feline thymoma-associated exfoliative dermatitis, nodular dermatofibrosis, feminization syndrome associated with testicular tumours, superficial necrolytic dermatitis and paraneoplastic pemphigus. The aetiology of most cutaneous paraneoplastic syndromes has remained elusive in both people and animals.
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Affiliation(s)
- Michelle M Turek
- School of Veterinary Medicine, Department of Surgical Sciences, University of Wisconsin-Madison, 2015 Linden Drive, Madison, WI 53706, USA.
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Abstract
Autonomic balance, a function generally under host control, is subject to modulation by other signalers. In some cases, modulation of host autonomic function through behavioral and physical stressors exerted by another individual may have negative consequences for the stress recipient by inducing sympathetic bias. Modulation of autonomic function may sometimes benefit one party at the expense of another. Tumors and HIV are examples of illegitimate signalers who may induce host sympathetic bias to promote their own growth and evade host immune surveillance. Paraneoplastic and paraviral syndromes such as hypertrophic osteoarthopathy, QTc prolongation, insomnia, and cachexia could be viewed as epiphenomena related to the tumoral and viral manipulation of host autonomic balance. In a more general framework, other paraneoplastic and paraviral syndromes may represent epiphenomena related to modulation of endocrine, cytokine, and autonomic functions by tumors and viruses to promote their own survival. Spatial distribution of cancers and viruses within the host may reflect affinity for strategic locations that facilitate manipulation of a variety of host functions including autonomic, endocrine, and cytokine regulation. A more general for understanding spatial distribution of diseases based on gradients of autonomic balance in the body are explored. Darwinian perspectives are discussed.
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Affiliation(s)
- A Joon Yun
- Department of Radiology, Stanford University, 470 University Avenue, Palo Alto, CA 94301, USA.
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Abstract
Acanthosis nigricans (AN) occurs most commonly in association with hyperinsulinaemia and more rarely as a paraneoplastic syndrome. It is also a feature of several genetic disorders. Indirect evidence suggests a role for tyrosine kinase growth factor receptor signalling in the pathogenesis of AN. Defects in the insulin receptor gene causing insulin resistance and AN are well recognized, but recent data in several other syndromes of this association, including lipodystrophic disorders, have identified causative defects in other pathways. The mechanism of AN due to insulin resistance is most probably direct or indirect activation of the insulin-like growth factor 1 receptor by high levels of circulating insulin. However, more direct evidence for abnormal tyrosine kinase receptor signalling in AN has been provided by studies of craniosynostosis and skeletal dysplasia syndromes with AN, which have identified activating mutations in fibroblast growth factor receptors.
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Affiliation(s)
- D Torley
- Department of Dermatology, South Glasgow University Hospitals NHS Trust, Glasgow G51 4TF, Scotland, U.K
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43
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Haase I, Hunzelmann N. Activation of epidermal growth factor receptor/ERK signaling correlates with suppressed differentiation in malignant acanthosis nigricans. J Invest Dermatol 2002; 118:891-3. [PMID: 11982771 DOI: 10.1046/j.1523-1747.2002.17631.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Scully C, Barrett WA, Gilkes J, Rees M, Sarner M, Southcott RJ. Oral acanthosis nigricans, the sign of Leser-Trélat and cholangiocarcinoma. Br J Dermatol 2001; 145:506-7. [PMID: 11531848 DOI: 10.1046/j.1365-2133.2001.04393.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Ameen M, Chopra S, Darvay A, Acland K, Chu AC. Erythema gyratum repens and acquired ichthyosis associated with transitional cell carcinoma of the kidney. Clin Exp Dermatol 2001; 26:510-2. [PMID: 11678878 DOI: 10.1046/j.1365-2230.2001.00879.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Both erythema gyratum repens (EGR) and acquired ichthyosis are distinctive dermatoses which have strong associations with internal malignancy. EGR usually precedes the diagnosis of malignancy whereas acquired ichthyosis commonly manifests after the detection of malignancy. We report a patient who initially presented with a figurate eruption of EGR which later developed into a widespread ichthyosis with disappearance of the serpiginous rash. Further investigations revealed an underlying transitional cell carcinoma of the kidney, an association which has not previously been reported with either EGR or acquired ichthyosis. The occurrence of two paraneoplastic skin disorders in the same patient may be explained by tumour cell secretion of transforming growth factor alpha, which has been shown to be mitogenic for keratinocytes.
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Affiliation(s)
- M Ameen
- Unit of Dermatology, Imperial College of Science, Technology and Medicine, Hammersmith Hospital, London, UK.
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46
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Abstract
Acanthosis nigricans (AN) is a disorder often accompanied by internal malignancy in adult patients, but in children it is usually benign. Generalized forms of AN, especially in childhood, are extremely rare. We report a 5-year-old boy with a 3-year history of AN who had generalized roughness and hyperpigmentation, numerous skin wrinkles, disseminated skin tags, tripe palms, and intensive pruritus. No clinical evidence of internal disorders, notably of an endocrinologic or neoplastic nature, have been detected thus far.
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Affiliation(s)
- D S Skiljevic
- Institute of Dermatology, University Clinical Center, Belgrade, Yugoslavia
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47
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Bottoni U, Dianzani C, Pranteda G, Innocenzi D, De Giacomo P, Balzani A, Zampetti M, Pala S, Calvieri S. Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer. J Eur Acad Dermatol Venereol 2000; 14:205-8. [PMID: 11032067 DOI: 10.1046/j.1468-3083.2000.00051.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This is the report of an 80-year-old patient with diffuse brownish hyperpigmentation and velvety thickening of the skin with onset 1 year before. Warty lesions on his limbs were present as well as papillomatous and verrucous lesions on his lips, mouth and eyelid conjunctivae with hyperkeratosis of the nipples. Biopsies, performed at different sites, showed histological pictures consistent with a diagnosis of acanthosis nigricans (AN) with florid cutaneous and mucosal papillomatosis. This type of AN is frequently associated with internal malignancy. In our patient serum levels of tissue polypeptide antigen, carcinoembryonic antigen, cytokeratin fragment and squamous cell carcinoma antigen were high and chest computed tomography scan indicated a large tumour infiltrating the right lung and extending to the mediastinum. Cytological examination of bronchial drainage revealed the presence of neoplastic cells, non-small cell type carcinoma. The most frequent cancer associated with malignant AN is gastric adenocarcinoma. Lung tumour has rarely been reported with AN. Malignant AN is sometimes associated with other cutaneous and mucosal warty lesions, as in our patient. These various skin and mucosal lesions are the expression of a systemic epithelial disorder and may help clinicians to suspect a malignant form of AN.
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Affiliation(s)
- U Bottoni
- Istituto di Dermatologia, Università di Roma La Sapienza, Italy.
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Yeh JS, Munn SE, Plunkett TA, Harper PG, Hopster DJ, du Vivier AW. Coexistence of acanthosis nigricans and the sign of Leser-Trélat in a patient with gastric adenocarcinoma: a case report and literature review. J Am Acad Dermatol 2000; 42:357-62. [PMID: 10640933 DOI: 10.1016/s0190-9622(00)90112-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- J S Yeh
- Department of Dermatology, King's College Hospital, London, United Kingdom
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Anderson SH, Hudson-Peacock M, Muller AF. Malignant acanthosis nigricans: potential role of chemotherapy. Br J Dermatol 1999; 141:714-6. [PMID: 10583123 DOI: 10.1046/j.1365-2133.1999.03116.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acanthosis nigricans is an uncommon skin condition characterized by hyperkeratosis and skin hyperpigmentation. Most causes are benign, but it may also be associated with gastrointestinal and other malignancies. When associated with malignant disease, the skin pathology may be more severe and treatment often unsuccessful. We describe a 66-year-old man with acanthosis nigricans associated with carcinoma of the stomach, with distressing generalized cutaneous, perioral and perineal disease, whose skin condition resolved completely with combination chemotherapy. In patients with malignant acanthosis, chemotherapy may relieve many of the distressing cutaneous symptoms. A close liaison between gastroenterologists, dermatologists and oncologists is required.
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Affiliation(s)
- S H Anderson
- The Kent and Canterbury Hospital, Ethelbert Road, Canterbury, Kent CT1 3NG, UK
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Ramirez-Amador V, Esquivel-Pedraza L, Caballero-Mendoza E, Berumen-Campos J, Orozco-Topete R, Angeles-Angeles A. Oral manifestations as a hallmark of malignant acanthosis nigricans. J Oral Pathol Med 1999; 28:278-81. [PMID: 10426202 DOI: 10.1111/j.1600-0714.1999.tb02039.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case of malignant acanthosis nigricans (AN) that initially manifested in the oral cavity. In the present report, the patient had typical clinical and histological findings of oral and esophageal AN, with subtle skin changes, associated with a gallbladder adenocarcinoma. The importance of the clinical oral examination is emphasized because the recognition of oral lesions led to the diagnosis of AN and to the following detection of the internal malignancy. Since the tumours associated with AN are highly malignant, it is of the utmost importance to recognize the skin and mucous membrane changes in adults.
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Affiliation(s)
- V Ramirez-Amador
- Universidad Autonoma Metropolitana-Xochimilco, Department of Health Care, Mexico D.F
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