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• W2143004493 abstract "To the Editor: A 74-year-old man presented with a rapidly growing, painful ulcer on his right leg that had appeared 1 month earlier at the site of a minor trauma. The physical examination revealed a 14.5 cm × 11 cm fibrinous and necrotic ulcer with a raised violaceous inflammatory edge. The clinical examination was otherwise normal, and the patient had no articular or digestive symptoms. General health was unremarkable. A biopsy specimen revealed a fibrinous and necrotic dermis with numerous neovessels and an abundant polymorphic inflammatory infiltrate of neutrophils extending in the subcutaneous tissue, with no sign of vasculitis. Pyoderma gangrenosum (PG) was diagnosed. Screening tests in search of an associated pathology, including a peripheral blood smear, showed a mild lymphopenia and a moderate inflammatory syndrome. Immunologic studies, protein electrophoresis, and prostatic specific antigen were normal. There was no proteinuria. A chest radiograph was normal, but abdominal and pelvic ultrasonograms showed a suspicious 4-cm mass in the right kidney. The findings were confirmed by thoracic, abdominal, and pelvic computed tomography. The mass had not been present on an abdominal ultrasonogram performed 6 months earlier. The patient underwent partial right nephrectomy; histologic examination showed complete resection of a renal adenocarcinoma with clear and acidophil cells. After failure of the initial treatment of the PG by surgical excision and corticosteroid ointments, the ulceration improved quickly after the nephrectomy with suitable dressings, and complete healing was attained after 8 months (Fig 1). There was no relapse after 24 months of follow-up.The three groups of pathologies most frequently associated with PG are inflammatory arthritis, inflammatory bowel disease, and hematologic malignancies.1Crowson A.N. Mihm Jr., M.C. Magro C. Pyoderma gangrenosum: a review.J Cutan Pathol. 2003; 30: 97-107Crossref PubMed Scopus (221) Google Scholar, 2Brooklyn T. Dunnill G. Probert C. Diagnosis and treatment of pyoderma gangrenosum.BMJ. 2006; 333: 181-184Crossref PubMed Scopus (209) Google Scholar Other causes are also reported, but the association with a solid cancer remains rather rarely described. Twenty-four cases of PG associated with a solid cancer have been reported in the literature (Table I). Nevertheless, the link between the PG and cancer is often uncertain, either because there is another pathology frequently associated with PG (12 cases), or because the chronology is unknown or makes the association unlikely (5 cases). The seven remaining cases, for which the causality link seems probable, are two gastric cancers, one of the oral cavity, one of the parotid gland, one of the hypopharynx, one of the breast, and one of the colon. To the best of our knowledge, there is only one reported case of PG associated with a renal cancer.3Meier F. Berner D. Scherwitz C. Rassner G. Metzler G. An unusual case of pyoderma gangrenosum with necrotizing granulomatous dermatitis [in German].J Dtsch Dermatol Ges. 2003; 1: 302-305PubMed Google Scholar But that case does not confirm the link between PG and renal cancer because of an associated monoclonal immunoglobulin (10 g/L), a finding very often related to PG (10% of PG cases). In our patient, the PG was associated exclusively with the renal cancer, and the surgical treatment of the neoplasm lead to resolution of the ulceration. These are two strong arguments that confirm the link between the PG and the renal adenocarcinoma. Indeed, treatment of PG is often difficult and relies above all on the treatment of a possible underlying disease.4Reichrath J. Bens G. Bonowitz A. Tilgen W. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients.J Am Acad Dermatol. 2005; 53: 273-283Abstract Full Text Full Text PDF PubMed Scopus (330) Google Scholar As a result, in all patients who present with PG of undetermined etiology, it seems important to search for an underlying causal solid malignancy.Table IReported cases of pyoderma gangrenosum associated with solid tumorsReferenceNGender, age (y)LocalizationUnderlying diseaseTreatmentEvolutionLee et al (Cutis 1976;18:791-4)1NANACarcinoid tumor of the ileum found on autopsyNANABeurey et al (Ann Dermatol Venereol 1977;104 :631-4)1F, 68Left leg and then incision scar of cancer of the breastMonoclonal dysglobulinemia α2κ2; adenocarcinoma of the left breast(1) Tumor removal; (2) oral corticosteroids; (3) ClofazimineHealing with clofamazineThomsen et al (Arch Dermatol 1979;115:851-2)1NANAHistory of adenocarcinoma of the colon treated by hemicolectomyClofazimineNAOrtonne et al (Ann Dermatol Venereol 1979;106:251-6)1F, 67Left legAcute myelomonocytic leukemia; ovarian cystadenocarcinoma 5 years previously treated with MelphalanCorticosteroid bolus + clofazimineNAPowell et al (Q J Med 1985;55:173-86)4NANATwo adenocarcinomas of the colon with long-standing chronic ulcerative colitis; 1 carcinoma of the bladder; 1 prostatic carcinomaNANAKuhn et al (Z Hautkr 1985;60:79-82)1F, 45LegsOral carcinoma; selective IgA defiencyClofazimine + oral corticosteroids + azathioprine + colchicineNACole et al (Cutis 1989;44:205-8)1F, 5558(1) Right breast + left thigh; (2) left malleolar areaMonoclonal dysglobulinemia IgAκ; (1) cosmetic breast reduction surgery + intramuscular injection in the left thigh; (2) adrenocortical carcinoma(1) Oral corticosteroids + dapsone; (2) adrenalectomy + glucocorticoids(1) Healing but recurrences; (2) healingPrystowsky et al (Arch Dermatol 1989;125:57-64)162Arms, right legSquamous cell carcinoma; Crohn diseaseIntralesional corticosteroidsNABaruch et al (Ann Chir Plast Esthet 1990;35:73-5)1F, 29BreastSeven days after mastectomy for cancer of the breastNANAMaigre et al (Rev Med Interne 1991;12:452-4)1F, 61ButtockIntramuscular injection of metopimazine into the buttock; metastatic cancer of the breast treated by chemotherapyClofazimine + corticosteroid bolusHealingBasille et al (Ann Dermatol Venereol 1992;119:381-3)1M, 80ArmsAcinous cell cancer of the parotid gland(1) Clofazimine; (2) Disulone; (3) parotidectomy + oral corticosteroidsHealing after parotidectomy + oral corticosteroidsGallo et al (Int J Dermatol 1995;34:713-4)1F, 67LegsGastric signet ring cell carcinoma(1) Cyclosporine ; (2) gastrectomyHealing after gastrectomyBayle-Lebey et al (Ann Med Interne 1995;146:585-7)1M, 56Right shoulderHypopharynx, adenocarcinomaHypopharyngectomyHealingLabat et al (Ann Med Interne 2000;151:314-5)1F, 39Scar of mastectomyMetastatic cancer of the breast (mastectomy 19 months earlier); cutaneous lesions concomitant of the discovery of hepatic metastasisOral corticosteroidsFailureCailhol et al (Gastroenterol Clin Biol 2003;27:955-7)1F, 74NAAdenocarcinoma of the sigmoid colonOral corticosteroidsNAMeier et al (J Dtsch Dermatol Ges 2003;1:302-5)1M, 64Legs, handsMonoclonal dysglobulinemia IgAl; renal carcinoma(1) Nephrectomy; (2) oral corticosteroids; (3) Dapsone; (4) thalidomideImprovement with thalidomideSakai et al (J Dermatol 2006;33:68-70)1F, 70PeristomalForty days after ileostomy for gastric and colic carcinomaNALocal corticosteroidsFranca et al (J Eur Acad Dermatol Venereol 2006;20:440-1)1M, 34Right footMetastatic gastric cancerOral corticosteroids + chemotherapyHealingJutley et al (J Cardiovasc Surg [Torino] 2007;48:394-5)1M, 67Scar of sternotomyFour days after sternotomy for coronary artery bypass; squamous cell bronchial carcinoma diagnosed 22 months after PGCorticosteroid bolus + oral corticosteroidsHealingDescheemaeker et al (J Gynecol Obstet Biol Reprod 2008;37:618-21)1F, 31Incision scar of cancer of the left breastSeven days after tumorectomy for in situ carcinoma of left breast; history of infiltrating carcinoma of right breast (tumorectomy, radiotherapy, and hormonotherapy 7 months earlier)Tumor removal + oral corticosteroidsHealingBunte et al (Scand J Gastroenterol 2008;43:756-8)1H, 53Right scapula (injury while gardening)Adenocarcinoma of the sigmoid colon(1) Oral corticosteroids + azathioprine; (2) hemicolectomy + chemotherapyHealing after hemicolectomy + chemotherapyF, Female; M, male; NA, not available. Open table in a new tab To the Editor: A 74-year-old man presented with a rapidly growing, painful ulcer on his right leg that had appeared 1 month earlier at the site of a minor trauma. The physical examination revealed a 14.5 cm × 11 cm fibrinous and necrotic ulcer with a raised violaceous inflammatory edge. The clinical examination was otherwise normal, and the patient had no articular or digestive symptoms. General health was unremarkable. A biopsy specimen revealed a fibrinous and necrotic dermis with numerous neovessels and an abundant polymorphic inflammatory infiltrate of neutrophils extending in the subcutaneous tissue, with no sign of vasculitis. Pyoderma gangrenosum (PG) was diagnosed. Screening tests in search of an associated pathology, including a peripheral blood smear, showed a mild lymphopenia and a moderate inflammatory syndrome. Immunologic studies, protein electrophoresis, and prostatic specific antigen were normal. There was no proteinuria. A chest radiograph was normal, but abdominal and pelvic ultrasonograms showed a suspicious 4-cm mass in the right kidney. The findings were confirmed by thoracic, abdominal, and pelvic computed tomography. The mass had not been present on an abdominal ultrasonogram performed 6 months earlier. The patient underwent partial right nephrectomy; histologic examination showed complete resection of a renal adenocarcinoma with clear and acidophil cells. After failure of the initial treatment of the PG by surgical excision and corticosteroid ointments, the ulceration improved quickly after the nephrectomy with suitable dressings, and complete healing was attained after 8 months (Fig 1). There was no relapse after 24 months of follow-up. The three groups of pathologies most frequently associated with PG are inflammatory arthritis, inflammatory bowel disease, and hematologic malignancies.1Crowson A.N. Mihm Jr., M.C. Magro C. Pyoderma gangrenosum: a review.J Cutan Pathol. 2003; 30: 97-107Crossref PubMed Scopus (221) Google Scholar, 2Brooklyn T. Dunnill G. Probert C. Diagnosis and treatment of pyoderma gangrenosum.BMJ. 2006; 333: 181-184Crossref PubMed Scopus (209) Google Scholar Other causes are also reported, but the association with a solid cancer remains rather rarely described. Twenty-four cases of PG associated with a solid cancer have been reported in the literature (Table I). Nevertheless, the link between the PG and cancer is often uncertain, either because there is another pathology frequently associated with PG (12 cases), or because the chronology is unknown or makes the association unlikely (5 cases). The seven remaining cases, for which the causality link seems probable, are two gastric cancers, one of the oral cavity, one of the parotid gland, one of the hypopharynx, one of the breast, and one of the colon. To the best of our knowledge, there is only one reported case of PG associated with a renal cancer.3Meier F. Berner D. Scherwitz C. Rassner G. Metzler G. An unusual case of pyoderma gangrenosum with necrotizing granulomatous dermatitis [in German].J Dtsch Dermatol Ges. 2003; 1: 302-305PubMed Google Scholar But that case does not confirm the link between PG and renal cancer because of an associated monoclonal immunoglobulin (10 g/L), a finding very often related to PG (10% of PG cases). In our patient, the PG was associated exclusively with the renal cancer, and the surgical treatment of the neoplasm lead to resolution of the ulceration. These are two strong arguments that confirm the link between the PG and the renal adenocarcinoma. Indeed, treatment of PG is often difficult and relies above all on the treatment of a possible underlying disease.4Reichrath J. Bens G. Bonowitz A. Tilgen W. Treatment recommendations for pyoderma gangrenosum: an evidence-based review of the literature based on more than 350 patients.J Am Acad Dermatol. 2005; 53: 273-283Abstract Full Text Full Text PDF PubMed Scopus (330) Google Scholar As a result, in all patients who present with PG of undetermined etiology, it seems important to search for an underlying causal solid malignancy. F, Female; M, male; NA, not available." @default.
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• W2143004493 title "Pyoderma gangrenosum associated with renal carcinoma" @default.
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