The Sign of Leser-Trelát and Malignant Acanthosis Nigricans Associated With Fallopian Tube Carcinoma

Abstract

BACKGROUND: The sign of Leser-Trelát is controversial and rarely reported in gynecologic malignancies. It is characterized by rapid development of new or enlarging seborrheic keratoses. CASE: A 78-year-old woman presented with unintentional weight loss and new-onset erythematous patches and plaques with thickened, rugated skin and stuck-on brown waxy papules on the chest and back. Her symptoms were concerning for a paraneoplastic eruption; workup revealed an elevated CA 125 level and an ovarian mass on abdominal computed tomography scan. Exploratory laparotomy revealed a stage IIIC serous fallopian tube carcinoma and a synchronous low-grade endometrioid adenocarcinoma of the endometrium. CONCLUSION: The sign of Leser-Trelát can be associated with fallopian tube carcinoma. When recognized, paraneoplastic dermatoses can prompt clinicians to initiate a workup for occult malignancy.

Leser-trelat sign in the diagnosis of occult neoplasms: Case report

“…It has been observed that in many patients who show the Leser-Trélat sign, another paraneoplastic disease occurs at the same time, so that a careful examination and precise anamnesis cannot be assessed. [2][3][4][5][6][7] As epidermal growth factor (EGF) receptors are present on basal keratinocytes, it has been suggested that greater importance should be given to combining molecular characteristics of multiple SKs with immunohistochemical analyzes of EGFR proteins to determine the likelihood of Leser-Trélat syndrome and consequently a high risk of disease. 8 At the same time, it is suggested for EGFR immunohistochemical analysis to be limited, i.e, to indicate the presence of LTS only when some additional clinical manifestations are present, such as: acute morphological changes in long-standing multiple SK, sudden, multiple "eruption" of SK, association with acanthosis or other paraneoplastic manifestations of the skin, a younger age of the patient at the onset of SK, and malignancies in personal and/or family history.…”

“…Occurrence of numerous seborrheic keratoses (especially if they are "eruptive", large and bizarre in shape [1][2][3][4][5][6][7] ), should raise suspicion of LT phenomenon, or internal malignancy in the patient, and result in relevant diagnostic procedures to detect possible latent malignancy. It would be wise for the doctors of all disciplines to be acquainted with the existence of the LT sign (syndrome) and the possible clinical implications of it.…”

“…1 The LT sign is considered to be a rather rare paraneoplastic skin marker of internal malignancy. [2][3][4][5] Seborrheic keratoses (SK) are very common benign skin changes in the population over 40 years old. SK are also found in completely healthy people.…”

“…In fact, overexpression of EGF-alpha and EGFR (epidermal growth factor receptor) may contribute to the eruptive nature of SK. [1][2][3][4][5][6][7] CASE HISTORY Patient M.O. 73 years old, came for the first time for a dermoscopic examination of the skin in June 2012 due to a change on the head, which was diagnosed as an intradermal nevus without significant elements.…”

Leser-Trelat Sign and Its Main Features: A Systematic Literature Review

“…However, it is believed that the multiple QS are the result of an exacerbated cell proliferation of keratinocytes stimulated by growth factors produced by the tumors themselves 11,15,20,21 . And, as they are more common in older people, some authors question their legitimacy as a predictor of malignancy 13,18,22,23 .…”