Malignant acanthosis nigricans: a case report
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CASE REPORT
Open Access
Malignant acanthosis nigricans: a case report Xiaoyan Zhang1,2, Rongjun Liu1, Yiyun Liu1, Shuang Zhang3 and Hong Qi1*
Abstract Background: To report a case of malignant acanthosis nigricans with two unusual aspects, including the patient’s young age and the development of filiform papillomas on the eyelid margins. Case presentation: A 30-year-old woman presented with dry eye symptoms. Examination revealed filiform papillomas on the eyelid margins, gums, lips, hands, and axillae and excessive pigmentation localized to the neck, axillae, and groin. Biopsies of stomach, pancreatic, and thyroid lesions revealed gastric adenocarcinoma, pancreatic adenocarcinoma, and thyroid cancer, respectively. Systemic investigations showed gastric adenocarcinoma with metastatic spread. The patient was ultimately diagnosed with malignant acanthosis nigricans and died 4 months later. Conclusions: Acanthosis nigricans on the eyelid margins with a velvety overgrowth is highly suggestive of an internal malignancy, and full systemic investigations are warranted in these cases. In this patient, early signs were ignored, leading to the loss of a timely diagnosis and treatment. Keywords: Dry eye disease, Gastric adenocarcinoma, Malignant acanthosis nigricans, Case report
Background Acanthosis nigricans is rare. It was independently described by Pollitzer [1] and Janovsky [2] in 1890. This disorder is characterized by hyperkeratotic, pigmented lesions on the neck, face, groin, umbilicus, and axillae. Velvety overgrowth of the skin at the flexures may be accompanied by filiform growths around the lips, tongue and hands [3]. There are two forms of acanthosis nigricans, benign and malignant, with the underlying disease mechanisms differing between the two types. Benign acanthosis nigricans can be caused by genetic and endocrine factors, obesity, and certain medications leading to elevated insulin levels [4]. Malignant acanthosis nigricans, on the other hand, is considered to represent a paraneoplastic syndrome co-occurring with cancers and is associated * Correspondence: [email protected] 1 Department of Ophthalmology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191 Beijing, PR China Full list of author information is available at the end of the article
with internal malignancies, particularly gastric adenocarcinomas (55–61%) [5]. Mucous membrane involvement is rare in acanthosis nigricans and is suggestive of the malignant form [6]. Here, we report the case of a patient presenting with bilateral filiform papillomas on the eyelid margins who was subsequently diagnosed with malignant acanthosis nigricans. Unlike benign acanthosis nigricans, malignant acanthosis nigricans has generally been reported to occur in older populations [7]. In this case report, however, the patient was only 30 years old.
Case presentation A 30-year-old woman presented to the ophthalmology department with a 3-month history of swollen eyelids margins and dryness of the eyes. She had previously been diagnos
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