Acanthosis nigricans in patient with breast cancer and hepatocellular carcinoma: case report and review of the literature

Abstract

Acanthosis nigricans (AN) is characterized by hyperpigmented, thickened skin plaques with a velvety texture. The histology of these lesions shows hyperkeratosis and dermal papillomatosis. According to the clinical data the key role in the development of acanthosis nigricans belongs to an excessive concentration of growth factors. Such condition is ofparticular interest because of its association with internal malignancies. Its malignant form is often associated with gastric adenocarcinoma (55-61%), though coexistence with a variety of other malignancies (ovarian cancer, endometrial carcinoma, bladder cancer, etc.) has been reported. Clinical case of patient with AN and coexisting breast cancer and hepatocellular carcinoma is presented. The severity of skin manifestations improved after chemotherapy, mastectomy and radiation therapy. However, skin hyperpigmentation relapsed after development of the hepatocellular carcinoma and the progression of the primary tumor. An underlying malignancy should be suspected in each case of AN.

Keywords

acanthosis nigricans / paraneoplastic syndrome / breast cancer / the hepatocellular carcinoma / insulin-like growth factor 1 / transforming growth factor a

References

[1] Politzer S. Acanthosis nigricancs, in International Atlas of Rare skin Diseases. London; K. Lewis and Co; 1891. ch.10: 1-3.

[2] Phiske M.M. An approach to acanthosis nigricans. Indian Dermatol. Online J. 2014; 5(3): 239-49. doi: 10.4103/2229-5178.137765.

[3] Burke J.P., Hale D.E., Hazuda H.P., Stern M.P. A quantitative scale of acanthosis nigricans. Diabetes Care. 1999; 22(10): 1655-9.

[4] Акимов В.Г. Роль дерматолога в ранней диагностике онкологических заболеваний. Consilium Medicum. Дерматология. 2015; 17(12): 68-72.

[5] Kubicka-Wolkowska J., Debska-Szmich S., Lisik-Habib M., Noweta M., Potemski P. Malignant acanthosis nigricans associated with prostate cancer: a case report. BMC Urol. 2014; 14: 88. doi: 10.1186/1471-2490-14-88.

[6] Ellis D.L., Kafka S.P., Chow J.C., Nanney L.B.,Inman W.H., McCadden M.E., King L.E.Jr. 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. N. Engl. J. Med. 1987; 317(25): 1582-7.

[7] Wilgenbus K., Lentner A., Kuckelkorn R., Handt S., Mittermayer C. Further evidence that acanthosis nigricans maligna is linked to enhanced secretion by the tumour of transforming growth factor alpha. Arch. Dermatol. Res. 1992; 284 (5): 266-70.

[8] Koyama 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 (1): 71-7. doi: 10.1007/BF01213299.

[9] Kondo Y., Umegaki N., Terao M., Murota H., Kimura T., Katayama I. A case of generalized acanthosis nigricans with positive lupus erythematosus-related autoantibodies and antimicrosomal antibody: autoimmune acanthosis nigricans? Case Rep. Dermatol. 2012; 4(1): 85-91. doi: 10.1159/000337751.

[10] Jakubovic B.D., Sawires H.F., Adam D.N. Occult cause of paraneoplastic acanthosis nigricans in a patient with known breast dcis: case and review. Curr. Oncol. 2012; 19(4): e299-302. doi:10.3747/co.19.997.

[11] Mekhail T.M., Markman M. Acanthosis nigricans with endometrial carcinoma: case report and review of the literature. Gynecol. Oncol. 2002; 84(2): 332-4.

[12] Serap D., Ozlem S., Melike Y., Alper D., Aynur A., Ata Turker A., Ardıc S. Acanthosis nigricans in a patient with lung cancer: a case report. Case Rep. Med. 2010; 2010: pii: 412159. doi: 10.1155/2010/412159.

[13] Olek-Hrab K., Silny W., Zaba R., Osmola-Mankowska A., Mackiewicz-Wysocka M., Danczak-Pazdrowska A. Co-occurrence of acanthosis nigricans and bladder adenocarcinoma - case report. Contemp. Oncol. (Pozn). 2013; 17(3): 327-30. doi:10.5114/wo.2013.35287.

[14] Singh S.K., Rai T. A rare case of malignant acanthosis nigricans in a lady with ovarian cancer. Indian Dermatol. Online J. 2013; 4(2): 125-7. doi:10.4103/2229-5178.110640.

[15] Кузнецова Н.П., Чащин А.Ю. К вопросу о паранеоплазиях кожи. Российский журнал кожных и венерических болезней. 2003; 6(5): 6-8.

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