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    Acantosis nigricans oral

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    Acantosis nigricans oral

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    © All Rights Reserved
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    15 views5 pages

    Acantosis Nigricans

    Uploaded by

    Mario Castro
    Acantosis nigricans oral

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
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    i Denmark Case report Oral manifestations as a hallmark of malignant acanthosis nigricans Ramirez-Amador V, Esquivel-Pedraza L Campos J, Orozco-Topete R, Angeles-An; Caballero-Mendoza E, Berumen- A: Oral manifestations as a hall ‘mark of malignant acanthosis nigricans. J Oral Pathol Med 1999; 28: 278.81 © Munk sard, 1999, ‘We present case of malignant acanthosis nigricans (AN) that initially manifest. ced in the oral cavity. In the present report, the patient had typical clinical and histologi ‘al findings of oral and esophage ed with a gallbladder adenocarcinoma, examination is emphasized because the re sal AN, with subtle skin changes, associ The importance of the clinical oral to the diag- nosis of AN and to the following detection of the internal malignancy. Since sd with AN are highly malignant, itis of the utmost import ance to recognize the skin and mucous membrane changes in adults The malignant form of acanthosis ni cans (AN) is @ cutaneous parancoplas: Ithough the un derlying neoplasia is most often 3 gas- tic adenocarcinoma, cancers of other sites and types also occur (3). Cutane- ous AN is characterized by hyperpig mented plaques commonly affecting axilla ritus and hyperkeratosis of palms and the nape and sides of the neck. Pru= soles (iylosis) have also been reported. owths may be found fon the eyelids, lips and oral mucosa as well as the esophageal, laryngeal and nasal mucosa (3). Since the earliest d scription of oral lesions in AN in 1909 G@), several authors have mentioned oral tin AN (2, 5-17), We pr cent a patient whose marked oral and Papillomatous. esophageal papillomatosis represented the frst sign of malignant AN. A gall bladder adeno. was subse- quently diagnosed. Case report A SS-yeur-old woman in-patient was seen at the Oral Diseases Clinic of the Dermatol Department at the Insti tuto Na Salva- dor Zubirin” in Mexico City in June 1998. She complained of a sore palate type It detected subsequently lary lesion om gingiva, buccal mucosa und dorsum of tongue Foxesiata eral (7) 73. F Oral and esophas — Papila ations on commis- Gastric adenocarcinoma Bormanan geal lesions sures, palate and esophagus type ddtacted subsequently KoztowsK1 & Niona (2) 60. M_—Skin lesions iyperpigmented skin plagues, pruti> Five months later metastatic aeno- tustand papdlomatous orl lesions: carinoma of undetermined primary sophageal polyps Site was diagnosed Nowacnt eta. (8) 70 M_—Hiypespigmentas — Hyperpigmented und nodular skin Subsequently lang adenocarcinoma tion of skin lesions: pupillary growths on ps buccal and lingual mucosa Anona et al (9) 50 Hypeepigmenta- Generalized skin hyperpigmentation Subsequently adenocarcinoma of tion of skin with verrucous growths: papilloma gallbladder tous lesion am the palate Haut et wl (10 G4 F Skin ions —_Cutanous thicksning and durken- Subsequently gastric adenocarcinoma poorly differentiated Mosrort etal (11) 47 F Beast adenocar- Hyperpigmented skin plagues: paplk Previously tated breast adenocare noma lomatous growths on lips gingiva, noma Fhuccal mucosa and palate Joust & Panekit (12) 59M Oral sions ———-Hyperpigmentod skin lesions: intra- Not found ‘orally there were papilomatous growths on buceal mucosa lips and literal horders of tongue Axpaeiy et al (13) 62—=« M_— Skin esions and Later florid papllomatous lesion of Simultaneously gastric adenocare pruritus Mixitatt sr Comsour & Game 56 M as) Bax (16) 2 Mm Roestox & Lesowrrz rth nocarcinoma bein type (61 manifestations can precede the detec: tion of cancer in 17% to 69% of the the neoplasia may be dis- at 60 simultaneously the most common ) Q). The onset of cutaneous ‘covered before, and in up to of cases, both occur sy Tt has been reported that approxi mately 30% to 40? jgnant AN ‘eases may involve the mucoste (1,19) The frequency of oral manifestations in AN has been estimated by some au- thors to be about S0% (4). In one series, Skin lesions Oral lesions Skin lesions M_ Skin lesions the oral miucost and extensive veeru- noma with metastases ‘ous lesions ofthe skin developed palimoplantae hyperkeratows an Trt tongue, ale sural mucosa Crpiementation papillomaous lesions embrane involv ) of the 17 pa tients who presented with the malignant form of AN (19). However, in a search of the English language literature from 1968 to 1998, we only found 13 reports of AN with oral lesions and ten with | involvernent (5-17) (Table 1), Also, there have been 13 case reports fon patients with malignant AN with esophageal lesions, in ten of whom oral oral_ mucous was found in six GS lesions were observed, in the Japanese Titerature (1969 t0 1991) (7) Although cutaneous changes have Verrucous cutaneous lesions; later sermilion border with papilomatosis Papillomatous lesions on base of ut. labial and commis Papillomatous lesions on buccal cosa, tom an lps: skit hyp Hyperpigmented skin plaques; oral Subsequently metastaizing squamous call carcinoma of eervie wert and transitional cel careinoma of bladder swore detected Not found Later a gastric adenocarcinoma with metastasis to the liver Not found been considered as the most important clinical marker of the AN-associated carcinoma, in our case the presence of ‘oral manifestations was the indicator for the diagnosis of AN and subs {quently for the identification of the gall- bladder adenocarcinoma, As shown in Table I, of the 13 reports of AN with oral involvement, the oral mucosal changes primary sign of disease in only two cases, in both of which an underlying malignancy wa not identified. There have been excep: tional reports of AN associated with were the adenocarsinoma of the gallbladder, and only one with oral manifestations, in the past 30 years (9, 20). In the present case, the clinical presentation of the skin lesions, alopecia, hyperkeratosis of palms and pruritus, was similar to that reported elsewhere (3). The clinical ap- pearances of the oral lesions were also ‘consistent with other reported «ases (5, 11). Although oral lesions in AN seem to follow a constant clinical pattern, thus simplifying their recognition, dif= ferential diagnosis must consider other conditions such as papillary hyperpla- sia, viral warts, white sponge nevus, he reditary benign intraepithelial dysker- atosis, Wegener's granulomatosis, pyos- tomatitis vegetans, Cowden disease and Darier’s disease. Marked microscopic differences have been observed between skin and mouth AN lesions, While cutaneous forms may show slight irregular acanthosis that al: ternates with areas of epidermal atrophy and dermal papillomatosis, the oral lesions have acanthosis and epithelial Papillary hyperplasia (10). Melanin de- position is absent in intraoral lesions. In the present case, in both the palate and esophageal biopsies, the immunohisto- I stain for HPV antigen was weakly positive in scattered cells: Using the PCR technique, HPV-35 was ider tified. Other authors, using immuno- histochemistry, have not found HPV an- tigen (5, 10). HPV types 31, 33 and that are frequently associated with cervi- ccal carcinoma have been rarely detected, in oral squamous papilloma, condyloma or carcinoma (21, 22). Using in situ hy bridization for the detection of HPV, type 35 has not been found in either nor- mal oral mucosa or squamous cell carci= noma (23), In our patient, the demo stration of HPV:35 could be considered aasan incidental finding. Tt has been reported that skin. and ‘mucosal changes found in AN are prob- ably caused by cancer products (1). It hhas been suggested that adenocarcino- ma secretion of transforming growth factor a stimulates the proliferation of keratinocytes involved with epithelial ‘growth factor receptor (24) It is inter= sting to note that clinical regression of mucocutaneous lesions has been ob- served after therapy of the related ean- cer (6-8, 14), as in the present case, Su I resection, radiotherapy and che- motherapy have been used for the treatment of the underlying malignan: cy; however, their therapeutic effect on the oral lesions is still uncertain, This case emphasizes the importance of the clinical oral examination because the oral lesions led to the diagnosis of AN and to the following detection of the internal malignaney. Since the tu mours associated with AN are highly malignant, itis of the utmost import ance to recognize the skin and mucous membrane changes in adults, {chnowledgemon ~ We thank Da, 1oas Fe Naxpo Gatitas Oxozco for his interest and care of the patient, Reterences 1 Kurznock R, Cony PR. Cutan prancoplastic syndromes in solid tu ‘mors. Amd Med 1995; 99: 662-71 Kortonski LM, Nicita TP. Esophage acanthosis nigricans in association with adenocarcinoma from an unknown pi: mary ste J Aim Acad Dermatol 992; 26: M51 Scuwaerz RA, Acanthosis nigricans, J Am Acad Dermatol 994; 31: 1-19. 4. Prsonona JH, Goats RJ, Oral changes in acanthosis nigricans (juvenile type, Survey of the iterature and report of & fase, deta Derm¥enereo! 1982, 42: 63 7 S. Tyusm MT, Ficanns G, SIERMAS IS vom RB, Rictzs JA. Malignant acu thosis nigricans with florid papillary oral lesions. Oral Surg Oral Me Oral Patol 1996, #1: 435.5, Nona J. Tacawa T. Acant cans with oral lesions and malignant isceral tumor: a case report. J Oral Maxillofac Surg 1992; 80: 169-72, Foxustimia H, FUxvsins M, Mizo- aM M, Tavaka T, Urbs H. Case re Port of an advanced gastric eancer asso

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