A case of squamous cell carcinoma of lung presenting with paraneoplastic type of acanthosis nigricans

Paraneoplastic Conjunctival Acanthosis Nigricans: A Case Report

PURPOSE

To report a patient who presented with red eye and diffuse palpebral conjunctival thickening and papillary growth bilaterally.

METHODS

A 63-year-old woman with a medical history of stage IV adenocarcinoma of the lung with metastasis to the bone, the lung, and the lymph nodes presented with redness and irritation of both eyes for 3 months. The patient has been treated with topical corticosteroids for 3 weeks with no relief of symptoms.

RESULTS

Clinical examination and pathology report of conjunctival biopsy confirmed the diagnosis of conjunctival acanthosis nigricans.

CONCLUSIONS

Conjunctival acanthosis nigricans is a rare paraneoplastic condition that resembles papilloma and can present a challenge in diagnosis. When acanthosis nigricans occurs after the diagnosis of malignancy, it can be an indicator of progression of the underlying condition. The diagnosis of conjunctival acanthosis nigricans in a patient with no history of cancer should prompt clinicians for further malignancy workup.

Paraneoplastic syndromes in lung cancer and their management

Paraneoplastic syndromes are most frequently associated with lung cancer. This review considers a variety of paraneoplastic syndromes associated with lung cancer and discusses their pathophysiology, clinical features and management options.

A case of acanthosis nigricans as a paraneoplastic syndrome with squamous cell lung cancer

A 55-year-old man presented with oral mucosal ulcers, blackening of both hands, and hyperpigmentation on axillary, anal, and inguinal regions for the last 3 months, which were all progressive. The patient was referred to the oncology department with the diagnosis of acanthosis nigricans for investigation of an underlying malignancy. He was a smoker. A computed tomography scan of thorax revealed enlarged mediastinal lymphadenopathies and a lesion on the left upper lobe. Fine-needle aspiration biopsy of the mediastinal lesion was consistent with squamous cell carcinoma, and biopsies of the skin and oral mucosal lesion also further confirmed the diagnosis of acanthosis nigricans. After docetaxel and cisplatin chemotherapy, a significant improvement in his skin and mucosal lesions was observed with almost complete resolution of the pulmonary lesion and the mediastinal lymph nodes.

Paraneoplastic syndromes associated with lung cancer

Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases. Paraneoplastic syndromes associated with lung cancer can impair various organ functions and include neurologic, endocrine, dermatologic, rheumatologic, hematologic, and ophthalmological syndromes, as well as glomerulopathy and coagulopathy (Trousseau’s syndrome). The histological type of lung cancer is generally dependent on the associated syndrome, the two most common of which are humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer. The symptoms often precede the diagnosis of the associated lung cancer, especially when the symptoms are neurologic or dermatologic. The proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators, such as hormones and hormone-like peptides, cytokines, and antibodies. Treating the underlying cancer is generally the most effective therapy for paraneoplastic syndromes, and treatment soon after symptom onset appears to offer the best potential for symptom improvement. In this article, we review the diagnosis, potential mechanisms, and treatments of a wide variety of paraneoplastic syndromes associated with lung cancer.