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Leser-Trélat syndrome in patients affected by six multiple metachronous primitive cancers.

Ponti G, Luppi G, Losi L, Giannetti A, Seidenari S - J Hematol Oncol (2010)

Bottom Line: Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas.Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers.Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology and Haematology, University of Modena and Reggio Emilia, Modena, Italy. giovanni.ponti@unimore.it

ABSTRACT
Leser-Trélat syndrome is characterized by the eruptive appearance of multiple seborrheic keratoses in association with underlying malignant disease. Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas. Herein, we present a case that we believe is the first report of the sign of Leser-Trélat in association with occult gastric adenocarcinoma and the anamnestic oncologic history of five other multiple primitive cancers. Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers. Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses. We propose the importance of combining the molecular features of multiple seborrheic keratoses with EGFR immunohistochemistry analyses to determine the likelihood of Leser-Trélat syndrome and the consequent high risk of underlying multiple visceral malignancies.

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Clinical presentation of innumerable seborrheic keratoses concentrated over the face, neck, back, and chest.
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Figure 1: Clinical presentation of innumerable seborrheic keratoses concentrated over the face, neck, back, and chest.

Mentions: A 83-year-old man was admitted to our hospital in August 2009 with a recent history of dyspnea, cough and dyspepsia. His medical history was characterized by sigmoidectomy and ileal-cecal resection for two synchronous adenocarcinomas (T1N0M0) in August 2008; localized adenocarcinoma of the prostate diagnosed in 2007 treated with hormonotherapy and radiotherapy with radical intent; cutaneous basal cell carcinoma and squamous cell carcinoma removed about 10 years before. For the past 25 years, he had noted multiple asymptomatic lesions, diagnosed as multiple seborrheic keratosis, of the face and trunk and these had recently increased in size and number with generalized pruritis. On admission, dermatologic examination noted florid eruption of innumerable keratotic lesions of the face, neck and thorax, ranging in size from 3 to 15 mm (Figure 1). Histopathological examination of a surgical skin biopsy confirmed the clinical diagnosis of seborrheic keratosis and was used for EGFR immunohistochemical analysis (Figure 2). Immunoperoxidase staining using diaminobenzidine as chromogen was run with the Benchmark XT automatic staining system (Ventana Medical Systems Inc, Strasbourg, France). Mouse monoclonal antibody anti-EGFR (clone 31G7; Ventana, Strasbourg, France) was used at a dilution of 1:100.


Leser-Trélat syndrome in patients affected by six multiple metachronous primitive cancers.

Ponti G, Luppi G, Losi L, Giannetti A, Seidenari S - J Hematol Oncol (2010)

Clinical presentation of innumerable seborrheic keratoses concentrated over the face, neck, back, and chest.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2820021&req=5

Figure 1: Clinical presentation of innumerable seborrheic keratoses concentrated over the face, neck, back, and chest.
Mentions: A 83-year-old man was admitted to our hospital in August 2009 with a recent history of dyspnea, cough and dyspepsia. His medical history was characterized by sigmoidectomy and ileal-cecal resection for two synchronous adenocarcinomas (T1N0M0) in August 2008; localized adenocarcinoma of the prostate diagnosed in 2007 treated with hormonotherapy and radiotherapy with radical intent; cutaneous basal cell carcinoma and squamous cell carcinoma removed about 10 years before. For the past 25 years, he had noted multiple asymptomatic lesions, diagnosed as multiple seborrheic keratosis, of the face and trunk and these had recently increased in size and number with generalized pruritis. On admission, dermatologic examination noted florid eruption of innumerable keratotic lesions of the face, neck and thorax, ranging in size from 3 to 15 mm (Figure 1). Histopathological examination of a surgical skin biopsy confirmed the clinical diagnosis of seborrheic keratosis and was used for EGFR immunohistochemical analysis (Figure 2). Immunoperoxidase staining using diaminobenzidine as chromogen was run with the Benchmark XT automatic staining system (Ventana Medical Systems Inc, Strasbourg, France). Mouse monoclonal antibody anti-EGFR (clone 31G7; Ventana, Strasbourg, France) was used at a dilution of 1:100.

Bottom Line: Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas.Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers.Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology and Haematology, University of Modena and Reggio Emilia, Modena, Italy. giovanni.ponti@unimore.it

ABSTRACT
Leser-Trélat syndrome is characterized by the eruptive appearance of multiple seborrheic keratoses in association with underlying malignant disease. Usually, the sign of Leser-Trélat is associated with adenocarcinoma, most frequently of the colon, breast, or stomach, but also of the lung, kidney, liver, and pancreas. Herein, we present a case that we believe is the first report of the sign of Leser-Trélat in association with occult gastric adenocarcinoma and the anamnestic oncologic history of five other multiple primitive cancers. Epidermal growth factor receptor (EGFR) immunohistochemical expression analysis of multiple seborrheic keratoses revealed an intense membranous staining in the basal keratinocytes and in all the upper epidermal layers. Patients with the sign of Leser-Trélat should undergo a diagnostic screening programme for malignant disease along with patients with known Leser-Trélat syndrome who present with a recent acute and florid eruption of their seborrheic keratoses. We propose the importance of combining the molecular features of multiple seborrheic keratoses with EGFR immunohistochemistry analyses to determine the likelihood of Leser-Trélat syndrome and the consequent high risk of underlying multiple visceral malignancies.

Show MeSH
Related in: MedlinePlus