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• W2071309431 abstract "To the Editor: Acanthosis nigricans (AN) is a cutaneous finding characterized by velvety, hyperkeratotic plaques that predominate on flexural surfaces of the neck, axillae and groin.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar Histologically, AN is characterized by papillomatosis and hyperkeratosis. When it is paraneoplastic it is called malignant AN. The onset of malignant AN may present with three other cutaneous signs: florid cutaneous papillomatosis (FCP), tylosis, and the sign of Leser-Trélat.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar, 2Gheeraert P. Goens J. Schwartz R.A. Lambert W.C. Schroeder F. Debusscher L. Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.Int J Dermatol. 1991; 30: 193-197Crossref PubMed Scopus (47) Google Scholar A 70-year-old male presented in November 2003 for evaluation of multiple verrucous lesions on his hands, forearms, feet, and lower legs, which had developed since the summer of 2003. During that time he had also noticed a diffuse brownish hyperpigmentation and velvety thickening of the skin in the axillae, inguinal region, and mammillary areolae. He complained of generalized pruritus and weight loss of 5 kg within the last 3 weeks. The patient had ceased smoking 15 years earlier (15 pack years [a pack year being the number of years a patient has smoked cigarettes multiplied by the number of packs per day]) and was treated with allopurinol for hyperuricemia. Physical examination revealed numerous skin-colored firm and non-pendunculated, verrucous papules (0.5-1 cm in diameter) covering the dorsal region of his hands, wrists (Fig 1), and ankles as well as the dorsal aspects of the shins and calves. The plantar surfaces were spared. The skin of the axillae (Fig 2) and groin was thick, hyperpigmented, and velvety in appearance. His palms and soles were thickened and rough. Furthermore, tripe palms were noted.Fig 2Acanthosis nigricans of the right axilla.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Results of complete blood count, serum chemistry, and urinalysis were normal except for an increased level of creatinine 1.5 mg/dl (normal, <1.3 mg/dl), thyroid stimulating hormone 5.8 μU/ml (0.1-4 μU/ml), squamous cell carcinoma (SCC) antigen 40.1 ng/ml (<1.5 ng/ml), and prostate-specific antigen 7.68 ng/ml (<4.5 ng/ml). Serum levels for hemoglobin (11.7 g/dl), iron (30 μg/l), and transferrin (1.46 g/l) were decreased. Fasting plasma glucose levels were slightly impaired (100 mg/dl; normal <100 mg/dl). A computed tomography scan revealed a 7 cm × 7.2 cm mass infiltrating the middle and upper lobe of the right lung, enlarged hilar and pretracheal lymph nodes, and thickening of the pleural interstitium and enlargement of the prostate. Upper gastrointestinal endoscopy revealed diffuse papillomatosis of the esophagus (Fig 3). Histologic examination of a wart-like skin lesion and a papillomatous esophageal lesion displayed pronounced hyperkeratosis, acanthosis, and papillomatosis. No evidence of human papilloma viral DNA was found by polymerase chain reaction. SCC of the lung and adenocarcinoma of the prostate were confirmed by biopsy. Despite chemotherapeutic treatment with carboplatin and vinorelbine, no improvement of the SCC of the lung and the cutaneous lesions was observed, and the patient died 6 months later. In general, malignant AN has a sudden onset with rapid spreading. Rarely it presents with other cutaneous and mucosal warty lesions (eg, CP).1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar, 2Gheeraert P. Goens J. Schwartz R.A. Lambert W.C. Schroeder F. Debusscher L. Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.Int J Dermatol. 1991; 30: 193-197Crossref PubMed Scopus (47) Google Scholar, 3Bottoni U. Dianzani C. Pranteda G. Innocenzi D. De Giacomo P. Balzani A. et al.Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer.J Eur Acad Dermatol Venereol. 2000; 14: 205-208Crossref PubMed Scopus (25) Google Scholar, 4Misch K.J. Griffiths W.A.D. Eady R.A.J. Warts as a presenting sign in acanthosis nigricans.Clin Exp Dermatol. 1983; 8: 651-656Crossref PubMed Scopus (10) Google Scholar In FCP, papillomas are most commonly located on the extremities, particularly on the backs of hands and wrists, but may disseminate to the entire body.2Gheeraert P. Goens J. Schwartz R.A. Lambert W.C. Schroeder F. Debusscher L. Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.Int J Dermatol. 1991; 30: 193-197Crossref PubMed Scopus (47) Google Scholar Furthermore, pachydermatoglyphy and intense pruritus frequently accompany malignant AN.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar, 2Gheeraert P. Goens J. Schwartz R.A. Lambert W.C. Schroeder F. Debusscher L. Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.Int J Dermatol. 1991; 30: 193-197Crossref PubMed Scopus (47) Google Scholar Generalized or localized pruritus, affecting the site of the papillomas, is also an important symptom in FCP, which sometimes may precede the onset of the papillomas.2Gheeraert P. Goens J. Schwartz R.A. Lambert W.C. Schroeder F. Debusscher L. Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.Int J Dermatol. 1991; 30: 193-197Crossref PubMed Scopus (47) Google Scholar Although the most frequently associated neoplasm is gastric adenocarcinoma, many other malignancies have been reported, including lung and prostate.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar, 5Fukushima H. Fukushima M. Mizokami M. Tanaka T. Ueda H. Case report of an advanced gastric cancer associated with diffuse protruded lesions at the angles of the mouth, oral cavity and the esophagus.Kurume Med J. 1991; 38: 123-127Crossref PubMed Scopus (13) Google Scholar, 6Longshore S.J. Taylor J.S. Kennedy A. Nurko S. Malignant acanthosis nigricans and endometrioid adenocarcinoma of the parametrium: the search for malignancy.J Am Acad Dermatol. 2003; 49: 541-543Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 7Rogers D.L. Acanthosis nigricans.Semin Dermatol. 1991; 10: 160-163PubMed Google Scholar Regardless of their site of origin adenocarcinomas are found histologically in most cases.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar, 6Longshore S.J. Taylor J.S. Kennedy A. Nurko S. Malignant acanthosis nigricans and endometrioid adenocarcinoma of the parametrium: the search for malignancy.J Am Acad Dermatol. 2003; 49: 541-543Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar According to the literature, endocrinopathies, such as hypothyroidism and diabetes mellitus, are known as possible causes of AN.8Matsuoka L.Y. Wortsman J. Gavin J.R. Goldman J. Spectrum of endocrine abnormalities associated with acanthosis nigricans.Am J Med. 1987; 83: 719-725Abstract Full Text PDF PubMed Scopus (49) Google Scholar In our patient, hypothyroidism was diagnosed and a therapy with levo-thyroxin was initiated. Despite this treatment, no remission of the cutaneous lesions occurred. Therefore, we consider hypothyroidism unlikely to be the causal underlying condition for AN. In our patient, SCC of the lung and prostate cancer were detected. It remains unclear which of the two tumors or whether both of them together had elicited malignant AN.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar, 3Bottoni U. Dianzani C. Pranteda G. Innocenzi D. De Giacomo P. Balzani A. et al.Florid cutaneous and mucosal papillomatosis with acanthosis nigricans revealing a primary lung cancer.J Eur Acad Dermatol Venereol. 2000; 14: 205-208Crossref PubMed Scopus (25) Google Scholar Because more cases of malignant AN are associated with lung cancer than prostate cancer, SCC of the lung was considered to be the more likely culprit in our patient.1Schwartz R.A. Acanthosis nigricans.J Am Acad Dermatol. 1994; 31: 1-19Abstract Full Text PDF PubMed Scopus (292) Google Scholar So far only a few cases of esophageal involvement with malignant AN have been reported.9Koyama S. Ikeda K. Sato M. Shibahara K. Yuhara K. Fukutomi H. et al.Transforming growth factor-alpha (TGF alpha)-producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF-alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus.J Gastroenterol. 1997; 32: 71-77Crossref PubMed Scopus (88) Google Scholar, 10Kozlowski L.M. Nigra T.P. Esophageal acanthosis nigricans in association with adenocarcinoma from an unknown primary site.J Am Acad Dermatol. 1992; 26: 348-351Abstract Full Text PDF PubMed Scopus (34) Google Scholar, 11Mignon F.C. Laroche L. Revuz J. Chatel A. Cattan D. Bader J.P. Acanthosis nigricans associated with diffuse esophageal papillomatosis.Nouv Presse Med. 1975; 4: 2507-2510PubMed Google Scholar The previously reported cases were associated with gastric adenocarcinoma, esophageal squamous carcinoma, and adenocarcinoma of unknown primary site.9Koyama S. Ikeda K. Sato M. Shibahara K. Yuhara K. Fukutomi H. et al.Transforming growth factor-alpha (TGF alpha)-producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF-alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus.J Gastroenterol. 1997; 32: 71-77Crossref PubMed Scopus (88) Google Scholar, 10Kozlowski L.M. Nigra T.P. Esophageal acanthosis nigricans in association with adenocarcinoma from an unknown primary site.J Am Acad Dermatol. 1992; 26: 348-351Abstract Full Text PDF PubMed Scopus (34) Google Scholar, 11Mignon F.C. Laroche L. Revuz J. Chatel A. Cattan D. Bader J.P. Acanthosis nigricans associated with diffuse esophageal papillomatosis.Nouv Presse Med. 1975; 4: 2507-2510PubMed Google Scholar Mignon et al11Mignon F.C. Laroche L. Revuz J. Chatel A. Cattan D. Bader J.P. Acanthosis nigricans associated with diffuse esophageal papillomatosis.Nouv Presse Med. 1975; 4: 2507-2510PubMed Google Scholar found the papillomas scattered diffusely in the esophagus. This finding was also observed in two other reports.9Koyama S. Ikeda K. Sato M. Shibahara K. Yuhara K. Fukutomi H. et al.Transforming growth factor-alpha (TGF alpha)-producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF-alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus.J Gastroenterol. 1997; 32: 71-77Crossref PubMed Scopus (88) Google Scholar, 10Kozlowski L.M. Nigra T.P. Esophageal acanthosis nigricans in association with adenocarcinoma from an unknown primary site.J Am Acad Dermatol. 1992; 26: 348-351Abstract Full Text PDF PubMed Scopus (34) Google Scholar To the best of our knowledge, this is the first report of esophageal AN associated with SCC of the lung and adenocarcinoma of the prostate in the English literature. This case illustrates the important role of malignant AN as a marker of internal malignancy and should therefore always prompt a thorough and extensive search for an underlying malignancy." @default.
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• W2071309431 title "Florid cutaneous papillomatosis with acanthosis nigricans in a patient with carcinomas of the lung and prostate" @default.
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