Autopsy and Case Reports
http://autopsyandcasereports.org/article/doi/10.4322/acr.2016.021
Autopsy and Case Reports
Article / Clinical Case Report

Acanthosis Nigricans associated with clear-cell renal cell carcinoma

Fernando Peixoto Ferraz de Campos, Margarita Rosa Aveiga Narvaez, Paola Vasconcellos Soares Reis, Augusto Cesar Marins Gomes, Daniela Kallíope de Sá Paraskevopoulos, Frederico Santana, Oscar Eduardo Hidetoshi Fugita

Abstract

Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC.

Keywords

Acanthosis nigricans, Carcinoma, Renal Cell, Paraneoplastic Syndromes

References

1. Smyth LG, Casey RG, Quinlan DM. Renal cell carcinoma presenting as an ominous matachronous scalp metastasis. Can Urol Assoc J. 2010;4(3):E64-6. PMid:23293689.

2. Sountoulides P, Metaxa L, Cindolo L. Atypical presentations and rare metastatic sites of renal cell carcinoma: a review of case reports. J Med Case Rep. 2011;5(1):429. http://dx.doi.org/10.1186/1752-1947-5-429. PMid:21888643.

3. Gharabaghi MA. Clinical Spectrum of Patients with Renal Cell Carcinoma. In: Amato R, editor. Emerging research and treatments in renal cell carcinoma. Rijeka: InTech; 2012 [cited 2016 Jan 5]. chap 10 ; p. 229-44. Available from: http://www.intechopen.com/books/emerging- research-and-treatments-in-renal-cellcarcinoma/clinical-spectrum-of-patients-with-renal-cell-carcinoma

4. Fottner A, Szalantzy M, Wirthmann L,  et al. Bone metastases from renal cell carcinoma: patient survival after surgical treatment. BMC Musculoskelet Disord. 2010;11(1):145-50. http://dx.doi.org/10.1186/1471-2474-11-145. PMid:20598157.

5. Klausner AP, Ost MC, Waterhouse RL Jr, Savage SJ. Occult renal cell carcinoma in a patient with polymyositis. Urology. 2002;59(5):773-6. http://dx.doi.org/10.1016/S0090-4295(02)01533-9. PMid:11992921.

6. Respicio G, Shwaiki W, Abeles MA. 58-year-old man with anti-Jo-1 syndrome and renal cell carcinoma: a case report and discussion. Conn Med. 2007;71(3):151-3. PMid:17405398.

7. Koukoulis A, Cimas I, Gómara S. Paraneoplastic opsoclonus associated with papillary renal cell carcinoma. J Neurol Neurosurg Psychiatry. 1998;64(1):137-8. http://dx.doi.org/10.1136/jnnp.64.1.137. PMid:9436748.

8. Roy MJ, May EF, Jabbari B. Life-threatening polyneuropathy heralding renal cell carcinoma. Mil Med. 2002;167(12):986-9. PMid:12502172.

9. Mohammed Ilyas MI, Turner GD, Cranston D. Human chorionic gonadotropin secreting clear cell renal cell carcinoma with paraneoplastic gynaecomastia. Scand J Urol Nephrol. 2008;42(6):555-7. http://dx.doi.org/10.1080/00365590802468834. PMid:19031270.

10.Hameed A, Pahuja A, Thwaini A, Nambirajan T. Subclavian vein thrombosis: an unusual presentation of renal cell carcinoma. Can Urol Assoc J. 2011;5(2):E27-8. http://dx.doi.org/10.5489/cuaj.10061. PMid:21470547.

11.Wallach JB, McGarry T, Torres J. Lymphangitic metastasis of recurrent renal cell carcinoma to the contralateral lung causing lymphangitic carcinomatosis and respiratory symptoms. Curr Oncol. 2011;18(1):e35-7. http://dx.doi.org/10.3747/co.v18i1.647. PMid:21331270.

12.Suyama H, Igishi T, Makino H,  et al. Bronchial artery embolization before interventional bronchoscopy to avoid uncontrollable bleeding: a case report of endobronchial metastasis of renal cell carcinoma. Intern Med. 2011;50(2):135-9. http://dx.doi.org/10.2169/internalmedicine.50.3818. PMid:21245638.

13.Teresa P, Grazia ZM, Doriana M, Irene P, Michele S. Malignant effusion of chromophobe renal-cell carcinoma: Cytological and immunohistochemical findings. Diagn Cytopathol. 2012;40(1):56-61. http://dx.doi.org/10.1002/dc.21599. PMid:22180239.

14.Okubo Y, Yonese J, Kawakami S,  et al. Obstinate cough as a sole presenting symptom of non-metastatic renal cell carcinoma. Int J Urol. 2007;14(9):854-5. http://dx.doi.org/10.1111/j.1442-2042.2007.01832.x. PMid:17760755.

15.Miyamoto MI, Picard MH. Left atrial mass caused by metastatic renal cell carcinoma: an unusual site of tumor involvement mimicking myxoma. J Am Soc Echocardiogr. 2002;15(8):847-8. http://dx.doi.org/10.1067/mje.2002.120508. PMid:12174358.

16.Gopan T, Toms SA, Prayson RA, Suh JH, Hamrahian AH, Weil RJ. Symptomatic pituitary metastases from renal cell carcinoma. Pituitary. 2007;10(3):251-9. http://dx.doi.org/10.1007/s11102-007-0047-5. PMid:17541748.

17.Cimino-Mathews A, Sharma R, Netto GJ. Diagnostic use of PAX8, CAIX, TTF-1, and TGB in metastatic renal cell carcinoma of the thyroid. Am J Surg Pathol. 2011;35(5):757-61. http://dx.doi.org/10.1097/PAS.0b013e3182147fa8. PMid:21451364.

18.Kranidiotis GP, Voidonikola PT, Dimopoulos MK, Anastasiou-Nana MI. Stauffer’s syndrome as a prominent manifestation of renal cancer: a case report. Cases J. 2009;2(1):49-52. http://dx.doi.org/10.1186/1757-1626-2-49. PMid:19144140.

19.Mueller TJ, Wu H, Greenberg RE,  et al. Cutaneous metastases from genitourinary malignancies. Urology. 2004;63(6):1021-6. http://dx.doi.org/10.1016/j.urology.2004.01.014. PMid:15183939.

20.Srinivasan N, Pakala A, Al-Kali A, Rathi S, Ahmad W. Papillary renal cell carcinoma with cutaneous metastases. Am J Med Sci. 2010;339(5):458-61. http://dx.doi.org/10.1097/MAJ.0b013e3181d5678d. PMid:20234300.

21.Arrabal-Polo MA, Arias-Santiago SA, Aneiros-Fernandez J, Burkhardt-Perez P, Arrabal-Martin M, Naranjo-Sintes R. Cutaneous metastases in renal cell carcinoma: a case report. Cases J. 2009;2(1):7948-51. http://dx.doi.org/10.4076/1757-1626-2-7948. PMid:19918439.

22.Dorairajan LN, Hemal AK, Aron M,  et al. Cutaneous metastases in renal cell carcinoma. Urol Int. 1999;63(3):164-7. http://dx.doi.org/10.1159/000030440. PMid:10738187.

23.Maynard JW, Christopher-Stine L, Gelber AC. Testicular pain followed by microscopic hematuria, a renal mass, palpable purpura, polyarthritis, and hematochezia. J Clin Rheumatol. 2010;16(8):388-91. http://dx.doi.org/10.1097/RHU.0b013e3181fe8bbe. PMid:21085014.

24.Klein T, Rotterdam S, Noldus J, Hinkel A. Bullous pemphigoid is a rara paraneoplastic syndrome in patients with renal cell carcinoma. Scand J Urol Nephrol. 2009;43(4):334-6. http://dx.doi.org/10.1080/00365590902811545. PMid:19308806.

25.Tebbe B, Schlippert U, Garbe C, Orfanos CE. Erythroderma “en nappes claires” as a marker of metastatic kidney cancer. Lasting, successful treatment with rIFN-alpha-2a. Hautarzt. 1991;42(5):324-7. PMid:1831444.

26.Palapattu GS, Kristo B, Rajfer J. Paraneoplastic syndromes in urologic malignancy: the many faces of renal cell carcinoma. Rev Urol. 2002;4(4):163-70. PMid:16985675.

27.Mitchel SW. Extensive encephaloid cancer of the subserous tissues of the peritoneum and pleura: Intensely bronzed-cloured skin; supra-renal capsules healthy. Proc. Path. Soc. Philad. 1867;3:35.

28.Politzer S. Acanthosis nigricans. In: Unna PG, Morris M, Besnier E, Duhring LA, editors. International atlas of rare skin diseases. London: HK Lewis & Co. Ltda; 1890. Pt. IV, No. XI, p. 6.

29.Janvosky V. Acanthosis nigricans. In: Unna PG, Morris M, Besnier E, Duhring LA, editors. International atlas of rare skin diseases. London: HK Lewis & Co. Ltda; 1890. Pt. IV, No. XI, p. 1.

30.Rendon MI, Cruz PD Jr, Sontheimer RD, Berg-stresser PR. Acanthosis nigricans: a cutaneous marker of tissue resistance to insulin. J Am Acad Dermatol. 1989;21(3 pt 1):461-9. http://dx.doi.org/10.1016/S0190-9622(89)70208-5. PMid:2674210.

31.Hud JA Jr, Cohen JB, Wagner JM, Cruz PD Jr. Prevalence and significance of acanthosis nigricans in an adult obese population. Arch Dermatol. 1992;128(7):941-4. http://dx.doi.org/10.1001/archderm.1992.01680170073009. PMid:1626961.

32.Kalus AA, Chien AJ, Olerud JE. Chapter 151: diabetes mellitus and other endocrine diseases. In: Goldsmith LA, Katz SI, Gilchrest BA,  et al ., editors. Fitzpatrick’s dermatology in general medicine. 8th ed. New York: McGraw-Hill; 2012.

33.Stulberg DL, Clark N, Tovey D. Common hyperpigmantation disorders in adults: part II. Melanoma, seborreic keratoses, acanthosis nigricans, melasma, diabetic dermopathy, tinea versicolor and post inflammatory hyperpigmentation. Am Fam Physician. 2003;68(10):1963-8. PMid:14655805.

34.Kubicka-Wołkowska J, Dębska-Szmich S, Lisik-Habib M, Noweta M, Potemski P. Malignant acanthosis nigricans associated with prostate cancer: a case report. BMC Urol. 2014;14(1):88. http://dx.doi.org/10.1186/1471-2490-14-88. PMid:25399333.

35.Pollitzer S. Acanthosis nigricans: a symptom of a disoreder of the abdominal sympathetic. JAMA. 1909;LIII(17):1369-73. http://dx.doi.org/10.1001/jama.1909.92550170001001g.

36.Rigel DS, Jacobs MI. Malignant acanthosis nigricans: a review. J Dermatol Surg Oncol. 1980;6(11):923-7. http://dx.doi.org/10.1111/j.1524-4725.1980.tb01003.x. PMid:6257767.

37.Moscardi JL, Macedo NA, Espasandin JA, Piñeyro MI. Malignant acanthosis nigricans associated with a renal tumor. Int J Dermatol. 1993;32(12):893-4. http://dx.doi.org/10.1111/j.1365-4362.1993.tb01410.x. PMid:8125695.

38.Lee HC, Ker KJ, Chong WS. Oral malignant acanthosis nigricans and tripe palms associated with renal urothelial carcinoma. JAMA Dermatol. 2015;151(12):1381-3. http://dx.doi.org/10.1001/jamadermatol.2015.2139. PMid:26309230.

39.Koyama S, Ikeda K, Sato M,  et al. Transforming growth factor alpha (TGF- alpha)–producing gastric carcinoma with acanthosis nigricans: an endocrine effect of TGF- alpha in the pathogenesis of cutaneous paraneoplastic syndrome and epithelial hyperplasia of the esophagus. J Gastroenterol. 1997;32(1):71-7. http://dx.doi.org/10.1007/BF01213299. PMid:9058298.

40.Krawczyk M, Mykała-Cieśla J, Kołodziej-Jaskuła A. Acanthosis nigricans as a paraneoplastic syndrome. Case reports and review of literature. Pol Arch Med Wewn. 2009;119(3):180-3. PMid:19514649.

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