Florid Cutaneous and Mucosal Papillomatosis: Mucocutaneous Markers of an Underlying Gastric Malignancy

Abstract

An 86-year female patient was referred to us for assessment of lip lesions and numerous cutaneous warty growths of 6-month duration. She had mild dysphagia but no systemic symptoms, including weight loss. Her only medication was risedronate for osteoporosis and she was otherwise healthy. Examination revealed confluent fine papillomatosis across the lip vermillion (Fig 1), which diffusely affected the mucosa of the oral cavity and oropharynx. There were several wartlike papules affecting the skin of her face, neck, and extremities (Fig 2). There was no cutaneous hyperpigmentation or velvety thickening.Histologic examination of cutaneous and mucosal lesions showed hyperkeratosis, acanthosis, and papillomatosis but no viral inclusion or vacuolar degeneration of keratinocytes. There was no evidence of human papillomavirus (HPV) by polymerase chain reaction. Results of complete blood count and serum chemistry were normal but tumor markers showed elevated carcinoembryonic antigen (19.3 ug/L; normal, 0 to 4 ug/L), which was suggestive of a gastrointestinal tract neoplasm. A computed tomography scan showed marked mural thickening of the gastric body and antrum and several enlarged, confluent upper abdominal lymph nodes. Upper gastrointestinal endoscopy revealed gastric mucosal friability and ulceration. Biopsies demonstrated a poorly differentiated carcinoma. Palliative measures were provided when the patient experienced a rapid deterioration in health, and she died after 3 months.The eruption of wart-like papules was suggestive of a viral genesis but, surprisingly, there was no evidence to support the presence of

Florid cutaneous papillomatosis as a marker of neoplastic recurrence

“…Every patient diagnosed with this condition has an underlying known or occult malignancy. The most commonly reported neoplasia is gastric adenocarcinoma [1][2][3][4][5][6][7][8][9][10][11][12]. However, it may occur in association with other intraabdominal malignancies, as well as lung or breast carcinoma and lymphoproliferative disorders [1-3, 10, 11].…”

“…Clinically, FCP presents as a sudden eruption of multiple verrucous papules and nodules resembling clusters of verrucae vulgaris [1][2][3][4][5][6][7][8][9]. These first appear on the extremities, particularly on the dorsa of hands and wrists and may later spread to involve the trunk, the face, and even the entire body.…”

“…Florid cutaneous papillomatosis (FCP) is a rare condition characterized by the abrupt appearance of numerous verrucous papules on the face, trunk, and extremities, that are morphologically identical to viral warts [1][2][3][4][5][6][7][8][9][10][11][12]. It is considered an obligatory paraneoplastic dermatosis, as it is always associated with an internal malignancy [1][2][3][4].…”

Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions

“…b Medium-power view of SGH in a 33-year-old male. This lesion of recent onset lacks a papillary architecture, but shows epithelial hyperplasia, spongiosis, an absent keratin layer, neutrophilic exocytosis, and a dense chronic inflammatory infiltrate in the connective tissue (original magnification × 100, Hematoxylin & eosin) [37,38] has only been detected in a few instances and no definitive viral cause has been recognized [35]. VX appears as a well-demarcated, painless, slow-growing, plaque or nodule with a verrucous or granular surface [32].…”

“…The sudden onset of florid papillomatosis of the lips, labial commissures or oral mucosa is characteristic of acanthosis nigricans, a paraneoplastic condition associated with gastrointestinal malignancy (Fig. 8a, b) [37,38]. Oral papillary lesions arranged linearly, distributed unilaterally or along the midline (following Blaschko's lines) are a feature of linear epidermal nevus [39,40], sebaceous nevus syndrome [41][42][43] and focal dermal hypoplasia [44,45].…”