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      Acral-type Malignant Acanthosis Nigricans Associated with Gastric Adenocarcinoma

      case-report

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          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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          Melanoma, growth factors, acanthosis nigricans, the sign of Leser-Trélat, and multiple acrochordons. A possible role for alpha-transforming growth factor in cutaneous paraneoplastic syndromes.

          W. Inman, E Chow, Christine E. King … (1987)
          Article 0 comments Cited 27 times – based on 0 reviews     Review now
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            Classification of acanthosis nigricans.

            H CURTH (1976)
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              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.

              Paloma M. Sato, T Tomiya, K Yuzawa … (1997)
              A case of well-differentiated adenocarcinoma (Borrmann type 3) of the stomach in a 76-year-old man associated with the typical skin manifestations of acanthosis nigricans and with multiple protruding lesions showing epithelial hyperplasia of the esophagus is reported. The advanced tumor was located in the cardiac region of the stomach, and measured approximately 8 cm in diameter, with partial invasion to the esophagus. The associated cutaneous lesions were characterized by hyperpigmentation and by protruding verrucous papules on the torso, head, face, neck, upper extremities, perineum, and inguinal region. Histologically, the protruding skin lesions showed keratinocytes proliferation throughout the epidermis, resulting in diffuse hyperkeratosis, papillomatosis, and acanthosis of the skin. Immunohistological analysis showed coexpression of transforming growth factor alpha (TGF-alpha) and epidermal growth factor (EGF) receptors in the tumor from the stomach. It is reasonable to conclude from this evidence that gastric carcinoma cells secrete TGF alpha in an autocrine for auto-stimulation. EGF receptor expression was also noted on the papillomatous hyperplasia of the cutaneous lesion. Serum level of TGF alpha, determined by an enzyme-linked immunosorbent assay, was high (144 pg/ml; normal, 22.0 +/- 16 pg/ml (Mean +/- SD)). Serum TGF alpha abruptly decreased to 49 pg/ml on day 7 after the total gastrectomy, and then gradually increased to 77 pg/ml within 28 days. Amelioration of the cutaneous lesions and the protruding lesions in the esophagus was observed after surgical resection of the gastric carcinoma. This suggests that the TGF alpha stimulates the proliferation of keratinocytes involved with EGF receptor. Large amounts of circulating TGF alpha in the blood over a long period released by the primary tumor seem to act as an endocrine-like mechanism causing epidermal and esophageal epithelial cells to proliferate. There is a possible link in the pathogenesis of the acanthosis nigricans as a cutaneous paraneoplastic syndrome, and epithelial hyperplasia of the esophagus.
              Article 0 comments Cited 11 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Dermatol
                Journal ID (publisher-id): AD
                Title: Annals of Dermatology
                Publisher: Korean Dermatological Association; The Korean Society for Investigative Dermatology
                ISSN (Print): 1013-9087
                ISSN (Electronic): 2005-3894
                Publication date (Print): October 2011
                Publication date (Electronic): 31 October 2011
                Volume: 23
                Issue: Suppl 2
                Pages: S208-S210
                Affiliations
                Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea.
                Author notes
                Corresponding author: Jeung-Hoon Lee, M.D., Department of Dermatology, Chungnam National University Hospital, 33 Munhwa-ro, Jung-gu, Daejeon 301-040, Korea. Tel: 82-42-280-7707, Fax: 82-42-280-7676, jhoon@ 123456cnu.ac.kr
                Article
                DOI: 10.5021/ad.2011.23.S2.S208
                PMC ID: 3229067
                PubMed ID: 22148052
                SO-VID: 92e2d345-adbe-4819-9b86-1c4b99ceedf7
                Copyright © Copyright © 2011 Korean Dermatological Association; The Korean Society for Investigative Dermatology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 March 2011
                Date revision received : 04 May 2011
                Date accepted : 06 May 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Dermatology
                Keywords: gastric adenocarcinoma,acral type,acanthosis nigricans
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: gastric adenocarcinoma, acral type, acanthosis nigricans

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