Malignant acanthosis nigricans and tripe palms in a patient with endometrial adenocarcinoma--a case report and review of literature.

BACKGROUND: In the world literature, uterine carcinoma associated with paraneoplastic malignant acanthosis nigricans and tripe palms has been mentioned in two review articles. Endometrial adenocarcinoma associated with malignant acanthosis nigricans without tripe palms has been cited in three case reports, and endometrial adenocarcinoma associated with tripe palms without malignant acanthosis nigricans has been cited in one case report. We present the case of a patient with endometrial adenocarcinoma associated with acanthosis nigricans and tripe palms which we have been following for the past 7 years. METHODS: Our 54-year-old patient had been operated for moderately differentiated endometrial adenocarcinoma. She had also received postoperative radiotherapy. RESULTS: Three years after surgery, tripe palms and acanthosis nigricans with generalized pruritus occurred. After treatment with etretinate, the skin symptoms were somewhat mitigated while the pruritus persisted. Six years after gynecologic treatment, a solitary inguinal metastatic lymph node of endometrial carcinoma was detected. Following lymphadenectomy there was additional but not complete mitigation of skin symptoms including pruritus. CONCLUSIONS: In clinical practice the association of malignant acanthosis nigricans and tripe palms with endometrial adenocarcinoma is found extremely rarely. Although the survival time of adenocarcinoma patients with malignant acanthosis nigricans is short, our patient has been treated and followed for more than 7 years.

[Acquired generalized cutis laxa with paraproteinemia (IgG lambda). Immunofluorescence study, clinical and histologic findings with review of the literature]. / Erworbene generalisierte Cutis laxa mit Paraproteinämie (IgG-lambda). Immunfluoreszenzstudie, Klinischer und histologischer Befund mit Literaturübersicht.

A 49-year-old patient developed acquired generalized cutis laxa, manifest as involvement of the elastic fibres of the dermis and the internal organs, leading to pulmonary emphysema, bilateral inguinal hernia and two oesophageal diverticula. The patient's serum levels of IgG lambda paraprotein were elevated. Direct immunofluorescence examination revealed intensive linear deposits of IgG lambda light chains, an early component of complement C1q and discrete C3 deposits. The deposits were found along the preserved elastic fibres in the dermis, especially in the papillary dermis, at the dermoepidermal junction around the sweat and sebaceous glands and in the walls of small vessels. Dermal alterations of this kind have not been described previously.

Psoriasis in the third age.

This study was performed during a 10-year period at several hospitalization centres from various districts in Slovenia and Croatia. The number of elderly patients, above 65 years, compared with the total number of inpatients in the aforementioned departments and clinics in the course of 10 years ranged from 12% to 25%. The percentage of psoriatics, according to the total number of elderly in-patients was 1.8% in Rijeka, 2.3% in Maribor, 4% in Celje and up to 6.1% in Zagreb. On the whole, 241 psoriatics (165 males and 76 females) were treated in the above centres during a 10-year period. The number of patients with psoriasis vulgaris was 214 on the whole; among them 13 presented with psoriasis arthropatica, 6 with pustular psoriasis (one with the palmo-plantar variety) and 8 with erythrodermic psoriasis. Retinoids (etretinate) increase serum lipids and decrease HDL cholesterol in the long-term treatment, thus increasing the already existing risk of atherosclerosis and of coronary heart diseases in older life age. Serum lipids, HDL and LDL cholesterol and A and B apolipoprotein are therefore monitorized each week when etretinate has been given.