CUTANEOUS SIGN OF MALIGNANCY, LESER-TRELAT, MULTIPLE SEBORRHEIC KERATOSES !
SIGNO CUTÁNEO DE MALIGNIDAD, LESER-TRELAT, QUERATOSIS SEBORREICAS MULTIPLES !
EDITORIAL ENGLISH
===================
Hello friends of the DERMAGIC EXPRESS network with this interesting
topic, THE SIGN OF LESER TRELAT as a cutaneous marker of malignancy.
My father, Old Dermatologist, always told me that the skin" speaks " and
which must be heard, and that we should observe what he "said". There are
some cutaneous manifestations that indicate that something is wrong inside
our body, which are a warning to take attention that can help us to
prolong our life.
Today through this bibliographic review I will show that when
the skin "speaks" Through this sign, known among the dermatologists of the world as
SIGN OF LESER-TRELAT (SLT),
there may be a malignancy inside you.
HISTORY:
1.) angiomas,
2.) pigmentary spots.
3.) SEBORRHEIC KERATOSES (KS)
as a early sign of cancer.
The senile angiomas were the least significant of these features. Later on
the same Hollander in a
new work insisted in the necessary association of the THREE TYPES OF
LESIONS and its association with malignancy, and also in
the sudden appearance and rapid development of the skins lesions. In his opinion the pigmentary spots
where the most important.
They were later studies where it was found that the main characteristic of the sign is the SEBORRHEIC KERATOSES, (KS). The main site of appearance of the lesions is THE BACK (see photos).
CLINICAL FEATURES:
1. Sudden and rapidly evolving appearance of multiple
seborrheic keratoses on the back, taking the shape of a "Christmas
tree."
2. Affected individuals: Adults, usually over 60 years
of age.
3. The lesions appear abruptly and usually increase
rapidly in size and number.
4. This sign is considered a
paraneoplastic syndrome, that is, a cutaneous manifestation that may
precede, coincide with, or follow a cancer diagnosis.
5. It
generally indicates the presence of an occult internal malignancy,
primarily adenocarcinoma, the most common being stomach and colon, as well
as breast and lung.
6. The percentage of association with
malignancy is considered to range from 26% to 55%.
Due to these
percentages, some authors and scientific publications later described a
"PSEUDO LESER-TRELAT SIGN (PLT),"
characterized by the same eruptive seborrheic keratoses in various
conditions, but without association with internal malignancy.
I
believe that these authors, LESER and TRELAT, became immortalized in that
century because they realized that cutaneous markers of internal
malignancy existed, and therefore I believe the LESER-TRELAT sign is a
reality.
PATHOGENESIS OR ETIOLOGY:
1.) Tumor-derived hormonal factors, such as transforming
growth factor alpha (TGF-α), which promote cell multiplication.
2.)
Epidermal growth factor receptors (EGFR), which stimulate rapid epidermal
proliferation, leading to the abrupt onset of multiple seborrheic
keratoses.
3.) Cytokine activation.
MALIGNANCY ASSOCIATED WITH THE SIGN OF LESER TRELAT:
1.) gastric adenocarcinoma.
2.) Pancreatic carcinoma.
3.) anaplastic ependymoma
4.) esophageal carcinoma.
5.) Sezary syndrome.
6.) carcinoma of the urinary tract
7.) Mycosis fungoides
8.) adenocarcinoma of the rectum.
9.) osteogenic sarcoma.
10.) Metastatic mucinous adenocarcinoma.
11.) malignant melanoma.
12.) Paraneoplastic rhinophyma
13.) primary lymphoma of the brain.
14.) adenocarcinoma of the gallbladder.
15.) adenocarcinoma of the duodenum.
16.) Adenocarcinoma of the stomach
17.) malignant Acanthosis nigricans.
18.) lung squamous cell carcinoma.
19.) breast adenocarcinoma.
20.) hepatocellular adenocarcinoma
21.) Bladder Carcinoma
22.) lung cancer.
23.) laryngeal carcinoma.
24.) Renal cell carcinoma.
25.) metastatic malignant melanoma.
26.) ovarian cancer.
27.) HEMATOLOGICAL CANCER.
Probably there are more associations ... So if you see these lesions
suddenly appear
on your back, do not
hesitate to go to the doctor.
In these references you know about this sign and many of its associations
with malignancy.
Greetings to all.
Dr. José Lapenta.
De. Jose M. Lapenta.
EDITORIAL ESPAÑOL
==================
Hola amigos de la red DERMAGIC EXPRESS con este tema bien
interesante, El SIGNO DE LESER TRELAT (SLT), como marcador cutáneo de malignidad.
Mi padre "Viejo" Dermatólogo, siempre me dijo que la piel "hablaba" y que
había que hacerle caso, o tomar en cuenta lo que "decía". Existen algunas
manifestaciones cutáneas que nos indican que algo anda mal dentro de
nuestro organismo, y que debemos tomar en cuenta, pues son un aviso para
que tomemos medidas las cuales pueden prolongar nuestra vida.
Hoy a través de esta revisión bibliográfica les voy a demostrar que
cuando la piel habla a través de este signo, conocido entre los dermatólogos del mundo como
SIGNO DE LESER- TRELAT puede haber una malignidad dentro de
ti.
HISTORIA:
Fueron los cirujanos Edmun LESER (Aleman) y
Ulysse TRELAT (Francia)
profesor de cirugía en Bordeaux, quienes a finales del siglo 18 describieron por vez primera la asociación de
tumores vasculares de la piel (angiomatosis senil) con
carcinoma y malignidad visceral.
Posteriormente le correspondió a
Hollander
en el año 1.900 (hace un siglo) la primera descripción de
"verrugas seborreicas" asociadas con CÁNCER interno. El describió la
ocurrencia simultánea de:
1.) angiomas.
2.) maculas pigmentadas.
3.) QUERATOSIS SEBORREICAS QS), como un signo temprano de cáncer.
Los angiomas seniles fueron los de menor significado. Posteriormente el
mismo
Hollander en un nuevo
trabajo insistió en en la asociación necesaria de los TRES TIPOS DE
LESIONES, y su asociación con malignidad y también en la APARICIÓN SÚBITA
Y RÁPIDO DESARROLLO de las lesiones. En su opinión las de mayor
significado fueron las máculas pigmentadas.
En posteriores estudios se encontró que la principal característica del
signo de LESER TRELAT (SLT), son las
QUERATOSIS SEBORREICAS, (QS), el
sitio principal de aparición de las lesiones es LA ESPALDA (ver
fotos).
CARACTERÍSTICAS CLÍNICAS:
1. - Aparición súbita y de rápida evolución de MÚLTIPLES QUERATOSIS
SEBORREICAS en LA ESPALDA, que adoptan la forma de un "arbolito de
navidad".
2.) Personas afectadas: adultos por lo general mayores de 60 años
de edad.
3.) Las lesiones aparecen abruptamente y aumentan por lo
general de tamaño y en número rápidamente.
4.) Este signo está considerado un síndrome paraneoplásico, es
decir, una manifestación cutánea que puede preceder, coincidir o seguir al
diagnóstico de cáncer.
5.) Por lo general, indica la presencia de una neoplasia maligna interna
oculta, principalmente ADENOCARCINOMAS, siendo los mas frecuentes:
ESTOMAGO y COLON, tambien MAMA y PULMÓN,
6.) Se considera que el porcentaje de asociación con MALIGNIDAD
varía entre un 26% al 55%.
Debido a estos porcentajes, posteriormente se describió por algunos
autores y publicaciones científicas, un
"PSEUDO SIGNO DE LESER TRELAT (PLT)"
caracterizado por las mismas QUERATOSIS SEBORREICAS ERUPTIVAS, en diversas
condiciones, pero sin asociación a malignidad interna.
Yo pienso que estos Autores LESER Y TRELAT se inmortalizaron en ese siglo
pues se dieron cuenta que existían marcadores cutáneos de malignidad
interna, y por ello creo que el signo LESER-TRELAT
es una realidad.
PATOGÉNESIS O ETIOLOGÍA:
1.) Factores hormonales derivados del tumor, como el factor de
crecimiento transformante alfa (TGF-α), que promueve la multiplicación
celular.
2.) Receptores del factor de crecimiento epidérmico (EGFR), que estimulan
una rápida proliferación epidérmica, que conduce a la aparición abrupta de
las MÚLTIPLES QUERATOSIS SEBORREICAS.
3.) Activación de citoquinas.
MALIGNIDADES ASOCIADAS AL SIGNO DE LESER TRELAT:
1.) adenocarcinoma gástrico.
2.) Carcinoma pancreático.
3.) ependimoma anaplásico
4.) carcinoma esofágico.
5.) Síndrome de SÉZARY.
6.) carcinoma de las vías urinarias
7.) Micosis fungoide
8.) adenocarcinoma del recto.
9.) sarcoma osteogénico.
10.) adenocarcinoma mucinoso metastásico.
11.) melanoma maligno.
12.) Rinofima paraneoplásico
13.) linfoma primario del cerebro.
14.) adenocarcinoma de la vesícula biliar.
15.) adenocarcinoma del duodeno.
16.) Adenocarcinoma del estómago
17.) Acantosis nigricans maligna,
18.) carcinoma de células escamosas pulmonares.
19.) adenocarcinoma de mama.
20.) adenocarcinoma HEPATOCELULAR
21.) Carcinoma de Vejiga
22.) cáncer de pulmón.
23.) carcinoma laríngeo.
24.) Carcinoma de células renales.
25.) melanoma maligno con METÁSTASIS.
26.) cáncer de ovario.
27.) CÁNCER heMATOLÓGICO.
Probablemente existan más asociaciones... de modo que si ves aparecer
estas lesiones repentinamente en tu ESPALDA no dudes en acudir al
médico.
En estas referencias conocerás sobre este signo cutáneo y muchas de las
malignidades asociadas.
Saludos a todos !!!
Dr. José Lapenta R.,,,
Dr. Jose M. Lapenta,,,
==================================================================
REFERENCIAS BIBLIOGRÁFICAS /
BIBLIOGRAPHICAL REFERENCES
===================================================================
A.- Sign and Pseudo-Sign of Leser-Trélat: Case Reports and a Review of
the Literature (2013).
I.- Sign of Leser-Trelat Associated with Waldenstrom's
Macroglobulinemia (2021).
===================================================================
1.) Coexistence of acanthosis nigricans and the sign of Leser-Trelat in a
patient with gastric adenocarcinoma: a case report and literature
review.
2.) Sign of Leser-Trelat.
3.) Pancreatic carcinoma associated with the Leser-Trelat sign.
4.) Leser-Trelat sign with anaplastic ependymoma--an autopsy case.
5.) The sign of Leser-Trelat associated with esophageal carcinoma.
6.) Hereditary onset of multiple seborrheic keratoses: a variant of Leser Trelat sign?
7.) Cutaneous paraneoplastic syndromes in solid tumors.
8.) Benign Leydig cell tumor of the testis associated with human papillomavirus type 33 presenting with the sign of Leser-
9.) A case of pancreatic cancer with the sign of Leser-Trelat.
10.) The sign of Leser-Trelat: a cutaneous sign of internal malignancy:
weakened subepithelial matrix from the effect of neoplasms on the extracellular matrix of the host.
11.) [Skin manifestation of internal malignancy].
12.) Leser-Trelat sign associated with Sezary syndrome.
13.) The sign of Leser-Trelat associated with transitional cell carcinoma of the urinary-bladder--a case report and short review.
14.) Mycosis fungoides with Leser-Trelat sign: the first report of a patient from Japan.
15.) The sign of Leser-Trelat associated with adenocarcinoma of the rectum.
16.) Seborrheic keratoses and cancer.
17.) The sign of Leser-Trelat in a young woman with osteogenic sarcoma.
18.) Sign of Leser-Trelat with a metastatic mucinous adenocarcinoma.
19.) The sign of Leser-Trelat: does it exist? [see
20.) The sign of Leser-Trelat associated with malignant melanoma.
21.) Paraneoplastic rhinophyma and the Leser-Trelat sign.
22.) Transformation of lymphocytoma cutis into a malignant lymphoma in association with the sign of Leser-Trelat.
23.) Leser-Trelat sign associated with Sezary syndrome.
24.) The sign of Leser-Trelat associated with primary lymphoma of the brain.
25.) Acanthosis nigricans and the sign of Leser-Trelat associated with
adenocarcinoma of the gallbladder.
26.) Bile duct adenocarcinoma with Leser-Trelat sign and pure red blood cell aplasia.
27.) The sign of Leser-Trelat. Report of a case with adenocarcinoma of
the duodenum.
28.) [The Leser-Trelat symptom: report of two cases
29.) Adenocarcinoma of the stomach with eruptive seborrheic keratoses: the sign of Leser-Trelat.
30.) Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.
31.) The relation between seborrheic keratoses and malignant solid tumours. A case-control study.
32.) Transformation of Sezary syndrome and the sign of Leser-Trelat: a histopathologic study.
33.) Sign of Leser-Trelat: report of two cases and review of the literature.
34.) Pemphigus foliaceus resembling eruptive seborrheic keratoses.
35.) Eruptive seborrheic keratoses in a young woman with acromegaly.
36.) Seborrheic keratosis and papillomatosis: markers of breast adenocarcinoma.
37.) A case of hepatocellular carcinoma with the sign of Leser-Trelat: a possible role of a cutaneous marker for internal malignancy.
38.) the relation between seborrheic keratoses and malignant solid tumours. A case-control study.
39.) [Useful cutaneous markers of internal malignancy in the early stage].
40.) [Gastrointestinal carcinoma with skin diseases from the standpoint of surgery].
41.) [Leser-Trelat sign in adenocarcinoma of the sigmoid colon--a rare clinical picture].
42.) [Acanthosis nigricans maligna and Leser-Trelat sign in double malignancy of the breast and stomach].
43.) Beitrage Zur Fruhdiagnose des darmcarcinoms (Hereditasverhaltnisse und Hautveranderungen)
===========================================================
J Am Acad Dermatol 2000 Feb;42(2 Pt 2):357-62
Yeh JS, Munn SE, Plunkett TA, Harper PG, Hopster DJ, du Vivier AW
Department of Dermatology, King's College Hospital, London, United
Kingdom.
The association of acanthosis nigricans (AN) with the sign of
Leser-Trelat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage-IV poorly differentiated, diffuse-type, adenocarcinoma of the gastric antrum was diagnosed.
The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The Patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed.
===========================================================
2.) Sign of Leser-Trelat.
===========================================================
J Am Acad Dermatol 1996 Jul;35(1):88-95 Related Articles, Books, LinkOut
Schwartz RA
New Jersey Medical School, Newark 07103-2714, USA.
The sign of Leser-Trelat is rare. It is defined as the sudden eruption of multiple seborrheic keratoses caused by a malignancy. Because both seborrheic keratoses and cancer are common in the elderly, it is not always easy to tell from the literature or in any given patient if thissign is present. In fact, its validity has been questioned. Its Association with malignant acanthosis nigricans is one of several of its features that support its legitimacy as a true paraneoplastic disorder.
===========================================================
3.) Pancreatic carcinoma associated with the Leser-Trelat sign.
===========================================================
Int J Pancreatol 1997 Oct;22(2):155-60 Related Articles, Books
Ohashi N, Hidaka N
Department of Surgery, Matsusaka Chuo Hospital, Mie, Japan.
A case of pancreatic carcinoma associated with the Leser-Trelat sign is reported. A 53-yr-old male had complained of mild epigastric discomfort and back pain accompanied by seborrheic keratoses, which had increased in size and number over the previous 6 mo.
A tumor was detected in the head of the pancreas and macroscopically curatively resected. His skin lesions diminished after surgery, but progressed again when the tumor recurred. Immunohistology for EGF showed a low level in the pancreatic carcinoma cells but a higher EGF content was recognized in the hyperkeratinized portions of the seborrheic keratoses. Of 130 underlying malignancies described in the 125 reported patients with the Leser-Trelat sign, neoplasms of the gastrointestinal tract were most common, comprising 47.7% of the total. The present case is the third case showing an association between a pancreatic carcinoma and theLeser-Trelat sign, but the first case for which the tumor of the pancreas was diagnosed in an early stage and resected surgically, as a result of the suggestive nature of this sign.
===========================================================
4.)Leser-Trelat sign with anaplastic ependymoma--an autopsy case.
===========================================================
Acta Neuropathol (Berl) 1997 Jan;93(1):97-100 Related Articles, Books,
LinkOut
Hamada Y, Iwaki T, Muratani H, Imayama S, Fukui M, Tateishi J
Department of Neuropathology, Faculty of Medicine, Kyushu University,
Fukuoka, Japan.
A 36-year-old Japanese male, who 7 years previously had been diagnosed as having an ependymoma in the left parietal region, had received surgery, chemotherapy and radiotherapy. He later developed a rapid growth of multiple skin lesions on his back and extremities, which coincided with a regrowth of the tumor. Postmortem examination revealed that the ependymoma showed anaplastic transformation and necrosis;however, no malignancy was observed in the extracranial organs. The skin lesions were histologically diagnosed as seborrheic keratoses. We have,therefore, diagnosed the patient as having Leser-Trelat sign associated with anaplastic ependymoma.
===========================================================
5.) The sign of Leser-Trelat associated with esophageal carcinoma.
===========================================================
Am J Gastroenterol 1996 Apr;91(4):802-4 Related Articles, Books, LinkOut
Chiba T, Shitomi T, Nakano O, Shimotono H, Yamada H, Fujimaki E, Orii S,
Sato K, Sato S
First Department of Internal Medicine, School of Medicine, Iwate Medical
University, Morioka, Japan.
A 79-year-old woman was admitted to our hospital with complaints of dysphagia and multiple verrucous papules that had developed over the previous year. The diagnosis of esophageal carcinoma was based on upper gastrointestinal radiography and endoscopic examination with biopsy. The Clinical syndrome was consistent with the sign of Leser-Trelat Associated with esophageal carcinoma. Although radiation therapy and chemotherapy were undertaken, the patient died 8 months later because of the sign of Leser-Trelat in association with squamous cell esophageal carcinoma.
===========================================================
6.) Hereditary onset of multiple seborrheic keratoses: a variant of Leser Trelat sign?
===========================================================
J Dermatol 1996 Mar;23(3):191-5 Related Articles, Books
Yamamoto T, Yokoyama A
Department of Dermatology, Tsuchiura Kyodo General Hospital, Ibaraki,
Japan.
A 79-year-old man in a cancer-prone family developed disseminated seborrheic keratoses over his trunk and extremities over a few decades without rapid increase. His son, mother, and one of his brothers, who died of gastric cancer, also had numerous seborrheic keratoses for a long time. He had a biliary tract cancer. Histologic examination showed hyper proliferation of basaloid cells branching downwards, as if induced by surrounding stroma. No decrease of the number of seborrheic keratosis after surgical operation has been observed. Examination for the localization of epidermal growth factor receptor (EGF-R) and HER-2/neu oncoprotein by immunohistochemistry revealed positive staining on the epithelial strands branching downwards on the specimens of seborrheic keratoses. A different pattern of expression was demonstrated in normal seborrheic keratosis. These findings suggest that some unidentified growth factors may be involved in the induction of visceral and/cutaneous neoplasms in this family.
===========================================================
7.) Cutaneous paraneoplastic syndromes in solid tumors.
2.) Sign of Leser-Trelat.
3.) Pancreatic carcinoma associated with the Leser-Trelat sign.
4.) Leser-Trelat sign with anaplastic ependymoma--an autopsy case.
5.) The sign of Leser-Trelat associated with esophageal carcinoma.
6.) Hereditary onset of multiple seborrheic keratoses: a variant of Leser Trelat sign?
7.) Cutaneous paraneoplastic syndromes in solid tumors.
8.) Benign Leydig cell tumor of the testis associated with human papillomavirus type 33 presenting with the sign of Leser-
9.) A case of pancreatic cancer with the sign of Leser-Trelat.
10.) The sign of Leser-Trelat: a cutaneous sign of internal malignancy:
weakened subepithelial matrix from the effect of neoplasms on the extracellular matrix of the host.
11.) [Skin manifestation of internal malignancy].
12.) Leser-Trelat sign associated with Sezary syndrome.
13.) The sign of Leser-Trelat associated with transitional cell carcinoma of the urinary-bladder--a case report and short review.
14.) Mycosis fungoides with Leser-Trelat sign: the first report of a patient from Japan.
15.) The sign of Leser-Trelat associated with adenocarcinoma of the rectum.
16.) Seborrheic keratoses and cancer.
17.) The sign of Leser-Trelat in a young woman with osteogenic sarcoma.
18.) Sign of Leser-Trelat with a metastatic mucinous adenocarcinoma.
19.) The sign of Leser-Trelat: does it exist? [see
20.) The sign of Leser-Trelat associated with malignant melanoma.
21.) Paraneoplastic rhinophyma and the Leser-Trelat sign.
22.) Transformation of lymphocytoma cutis into a malignant lymphoma in association with the sign of Leser-Trelat.
23.) Leser-Trelat sign associated with Sezary syndrome.
24.) The sign of Leser-Trelat associated with primary lymphoma of the brain.
25.) Acanthosis nigricans and the sign of Leser-Trelat associated with
adenocarcinoma of the gallbladder.
26.) Bile duct adenocarcinoma with Leser-Trelat sign and pure red blood cell aplasia.
27.) The sign of Leser-Trelat. Report of a case with adenocarcinoma of
the duodenum.
28.) [The Leser-Trelat symptom: report of two cases
29.) Adenocarcinoma of the stomach with eruptive seborrheic keratoses: the sign of Leser-Trelat.
30.) Florid cutaneous papillomatosis, malignant acanthosis nigricans, and pulmonary squamous cell carcinoma.
31.) The relation between seborrheic keratoses and malignant solid tumours. A case-control study.
32.) Transformation of Sezary syndrome and the sign of Leser-Trelat: a histopathologic study.
33.) Sign of Leser-Trelat: report of two cases and review of the literature.
34.) Pemphigus foliaceus resembling eruptive seborrheic keratoses.
35.) Eruptive seborrheic keratoses in a young woman with acromegaly.
36.) Seborrheic keratosis and papillomatosis: markers of breast adenocarcinoma.
37.) A case of hepatocellular carcinoma with the sign of Leser-Trelat: a possible role of a cutaneous marker for internal malignancy.
38.) the relation between seborrheic keratoses and malignant solid tumours. A case-control study.
39.) [Useful cutaneous markers of internal malignancy in the early stage].
40.) [Gastrointestinal carcinoma with skin diseases from the standpoint of surgery].
41.) [Leser-Trelat sign in adenocarcinoma of the sigmoid colon--a rare clinical picture].
42.) [Acanthosis nigricans maligna and Leser-Trelat sign in double malignancy of the breast and stomach].
43.) Beitrage Zur Fruhdiagnose des darmcarcinoms (Hereditasverhaltnisse und Hautveranderungen)
44.) Seborrheic Keratoses as the First Sign of Bladder Carcinoma: Case
Report of Leser-Trélat Sign in a Rare Association with Urinary Tract
Cancer.
45.) Leser-Trélat Sign in Tumor-Stage Mycosis Fungoides.
46.) Cutaneous manifestations of lung cancer.
47.) Leser-Trelat sign with primary hepatic carcinoma.
48.) Clinical image in gastroenterology. The sign of Leser-Trélat
associated with rectal carcinoma.
49.) [Leser-Trélat sign associated with gastric cancer: report of one
case].
50.) Sign of Leser-Trélat in association with laryngeal carcinoma.
51.) [Leser-Trelat sign associated with pancreatic cancer].
52.) Sign of leser-trélat associated with esophageal squamous cell
cancer.
53.) Leser-Trélat sign: does it really exist?
54.) Sign and pseudo-sign of Leser-Trélat: case reports and a review of
the literature.
55.) Chemotherapy-induced inflammatory seborrheic keratoses in a man
with acute myeloid leukemia: a variant of Leser-Trélat sign?
56.) [Clinical and histopathological characteristics of early
Leser-Trélat syndrome].
57.) A Case of Leser-Trélat Syndrome Associated with a Renal Cell
Carcinoma.
58.) Leser-Trélat Sign without Internal Malignancy.
59.) Leser-Trelat sign in metastasized malignant melanoma.
60.) Trélat sign presenting in a patient with ovarian cancer: a case
report.
===========================================================
===========================================================
1.) Coexistence of acanthosis nigricans and the sign of Leser-Trelat in a
patient with gastric adenocarcinoma: a case report and literature
review.===========================================================
J Am Acad Dermatol 2000 Feb;42(2 Pt 2):357-62
Yeh JS, Munn SE, Plunkett TA, Harper PG, Hopster DJ, du Vivier AW
Department of Dermatology, King's College Hospital, London, United
Kingdom.
The association of acanthosis nigricans (AN) with the sign of
Leser-Trelat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage-IV poorly differentiated, diffuse-type, adenocarcinoma of the gastric antrum was diagnosed.
The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The Patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed.
===========================================================
2.) Sign of Leser-Trelat.
===========================================================
J Am Acad Dermatol 1996 Jul;35(1):88-95 Related Articles, Books, LinkOut
Schwartz RA
New Jersey Medical School, Newark 07103-2714, USA.
The sign of Leser-Trelat is rare. It is defined as the sudden eruption of multiple seborrheic keratoses caused by a malignancy. Because both seborrheic keratoses and cancer are common in the elderly, it is not always easy to tell from the literature or in any given patient if thissign is present. In fact, its validity has been questioned. Its Association with malignant acanthosis nigricans is one of several of its features that support its legitimacy as a true paraneoplastic disorder.
===========================================================
3.) Pancreatic carcinoma associated with the Leser-Trelat sign.
===========================================================
Int J Pancreatol 1997 Oct;22(2):155-60 Related Articles, Books
Ohashi N, Hidaka N
Department of Surgery, Matsusaka Chuo Hospital, Mie, Japan.
A case of pancreatic carcinoma associated with the Leser-Trelat sign is reported. A 53-yr-old male had complained of mild epigastric discomfort and back pain accompanied by seborrheic keratoses, which had increased in size and number over the previous 6 mo.
A tumor was detected in the head of the pancreas and macroscopically curatively resected. His skin lesions diminished after surgery, but progressed again when the tumor recurred. Immunohistology for EGF showed a low level in the pancreatic carcinoma cells but a higher EGF content was recognized in the hyperkeratinized portions of the seborrheic keratoses. Of 130 underlying malignancies described in the 125 reported patients with the Leser-Trelat sign, neoplasms of the gastrointestinal tract were most common, comprising 47.7% of the total. The present case is the third case showing an association between a pancreatic carcinoma and theLeser-Trelat sign, but the first case for which the tumor of the pancreas was diagnosed in an early stage and resected surgically, as a result of the suggestive nature of this sign.
===========================================================
4.)Leser-Trelat sign with anaplastic ependymoma--an autopsy case.
===========================================================
Acta Neuropathol (Berl) 1997 Jan;93(1):97-100 Related Articles, Books,
LinkOut
Hamada Y, Iwaki T, Muratani H, Imayama S, Fukui M, Tateishi J
Department of Neuropathology, Faculty of Medicine, Kyushu University,
Fukuoka, Japan.
A 36-year-old Japanese male, who 7 years previously had been diagnosed as having an ependymoma in the left parietal region, had received surgery, chemotherapy and radiotherapy. He later developed a rapid growth of multiple skin lesions on his back and extremities, which coincided with a regrowth of the tumor. Postmortem examination revealed that the ependymoma showed anaplastic transformation and necrosis;however, no malignancy was observed in the extracranial organs. The skin lesions were histologically diagnosed as seborrheic keratoses. We have,therefore, diagnosed the patient as having Leser-Trelat sign associated with anaplastic ependymoma.
===========================================================
5.) The sign of Leser-Trelat associated with esophageal carcinoma.
===========================================================
Am J Gastroenterol 1996 Apr;91(4):802-4 Related Articles, Books, LinkOut
Chiba T, Shitomi T, Nakano O, Shimotono H, Yamada H, Fujimaki E, Orii S,
Sato K, Sato S
First Department of Internal Medicine, School of Medicine, Iwate Medical
University, Morioka, Japan.
A 79-year-old woman was admitted to our hospital with complaints of dysphagia and multiple verrucous papules that had developed over the previous year. The diagnosis of esophageal carcinoma was based on upper gastrointestinal radiography and endoscopic examination with biopsy. The Clinical syndrome was consistent with the sign of Leser-Trelat Associated with esophageal carcinoma. Although radiation therapy and chemotherapy were undertaken, the patient died 8 months later because of the sign of Leser-Trelat in association with squamous cell esophageal carcinoma.
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6.) Hereditary onset of multiple seborrheic keratoses: a variant of Leser Trelat sign?
===========================================================
J Dermatol 1996 Mar;23(3):191-5 Related Articles, Books
Yamamoto T, Yokoyama A
Department of Dermatology, Tsuchiura Kyodo General Hospital, Ibaraki,
Japan.
A 79-year-old man in a cancer-prone family developed disseminated seborrheic keratoses over his trunk and extremities over a few decades without rapid increase. His son, mother, and one of his brothers, who died of gastric cancer, also had numerous seborrheic keratoses for a long time. He had a biliary tract cancer. Histologic examination showed hyper proliferation of basaloid cells branching downwards, as if induced by surrounding stroma. No decrease of the number of seborrheic keratosis after surgical operation has been observed. Examination for the localization of epidermal growth factor receptor (EGF-R) and HER-2/neu oncoprotein by immunohistochemistry revealed positive staining on the epithelial strands branching downwards on the specimens of seborrheic keratoses. A different pattern of expression was demonstrated in normal seborrheic keratosis. These findings suggest that some unidentified growth factors may be involved in the induction of visceral and/cutaneous neoplasms in this family.
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7.) Cutaneous paraneoplastic syndromes in solid tumors.
===========================================================
Am J Med 1995 Dec;99(6):662-71 Related Articles, Books
Kurzrock R, Cohen PR
Department of Clinical Investigation, University of Texas M.D. AndersonCancer Center, Houston 77030, USA.
OBJECTIVE:
To provide an overview of the clinical manifestations, pathophysiology, and oncologic implications of the cutaneous paraneoplastic syndromes that occur predominantly in patients with solid tumors. METHODS: A review was performed of the literature identified bya comprehensive MEDLINE search.
RESULTS:
Diverse cutaneous paraneoplastic syndromes may be associated with underlying tumors. They include musculoskeletal disorders (clubbing, hypertrophic osteoarthropathy, dermatomyositis, and multicentric reticulohistiocytosis), reactive erythemas (erythema gyratum repens and necrolytic migratory erythema), vascular dermatoses (Trousseau's syndrome), papulosquamous disorders (acanthosis nigricans, tripe palms,palmar hyperkeratosis, acquired ichthyosis, pityriasis rotunda, Bazex's syndrome, florid cutaneous papillomatosis, the sign of Leser-Trelat, and extramammary Paget's disease), and disorders of hair growth(hypertrichosis lanuginosa acquisita). The clinical manifestations of these dermatoses may precede, coincide with, or follow the diagnosis of cancer. The presence of a cutaneous paraneoplastic syndrome is often associated with a poor prognosis.
CONCLUSIONS: Cutaneous paraneoplastic syndromes are specific constellations of mucous membrane and/or skin abnormalities that are caused by an underlying tumor. Since they may be the presenting sign of an occult cancer, cognizance of their features and clinical implications are of considerable importance. Individuals With these syndromes should have a thorough workup for an associated malignancy.
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8.) Benign Leydig cell tumor of the testis associated with human papillomavirus type 33 presenting with the sign of Leser-Trelat.
Am J Med 1995 Dec;99(6):662-71 Related Articles, Books
Kurzrock R, Cohen PR
Department of Clinical Investigation, University of Texas M.D. AndersonCancer Center, Houston 77030, USA.
OBJECTIVE:
To provide an overview of the clinical manifestations, pathophysiology, and oncologic implications of the cutaneous paraneoplastic syndromes that occur predominantly in patients with solid tumors. METHODS: A review was performed of the literature identified bya comprehensive MEDLINE search.
RESULTS:
Diverse cutaneous paraneoplastic syndromes may be associated with underlying tumors. They include musculoskeletal disorders (clubbing, hypertrophic osteoarthropathy, dermatomyositis, and multicentric reticulohistiocytosis), reactive erythemas (erythema gyratum repens and necrolytic migratory erythema), vascular dermatoses (Trousseau's syndrome), papulosquamous disorders (acanthosis nigricans, tripe palms,palmar hyperkeratosis, acquired ichthyosis, pityriasis rotunda, Bazex's syndrome, florid cutaneous papillomatosis, the sign of Leser-Trelat, and extramammary Paget's disease), and disorders of hair growth(hypertrichosis lanuginosa acquisita). The clinical manifestations of these dermatoses may precede, coincide with, or follow the diagnosis of cancer. The presence of a cutaneous paraneoplastic syndrome is often associated with a poor prognosis.
CONCLUSIONS: Cutaneous paraneoplastic syndromes are specific constellations of mucous membrane and/or skin abnormalities that are caused by an underlying tumor. Since they may be the presenting sign of an occult cancer, cognizance of their features and clinical implications are of considerable importance. Individuals With these syndromes should have a thorough workup for an associated malignancy.
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8.) Benign Leydig cell tumor of the testis associated with human papillomavirus type 33 presenting with the sign of Leser-Trelat.
===========================================================
J Urol 1993 Oct;150(4):1246-50 Related Articles, Books
Martin RW 3d, Rady P, Arany I, Tyring SK
Department of Dermatology, Johns Hopkins School of Medicine, Baltimore,Maryland.
We present a case of a benign testicular Leydig cell tumor and eruptive seborrheic keratosis associated with human papillomavirus type 33infection. To our knowledge this is the first occurrence of a Leydig Cell tumor in a patient with tuberous sclerosis and the second documented case of eruptive seborrheic keratoses (sign of Leser-Trelat)associated with a benign neoplasm.
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9.) A case of pancreatic cancer with the sign of Leser-Trelat.
===========================================================
Nippon Geka Hokan 1993 Jul 1;62(4):203-8 Related Articles, Books
Hirano T, Yoshioka H, Manabe T
Department of Surgery, Yoshioka Hospital, Kyoto, Japan.
A case of 79-year-old man with pancreatic cancer associated with the sign of Leser-Trelat was presented. Abdominal CT scanning was performed and a pancreatic tail tumor involving the spleen and the greater omentum as well as ascitic retention were detected. Ba-enema study showed the stenosis of the sigmoid colon, suggesting the peritoneal disseminations.Absolute non-curative operation of side-to-side transverso-sigmoidostomy was performed for colonic stenosis, and biopsy of the disseminated omental tumor was performed, which was histologically diagnosed as well differentiated papillary adenocarcinoma compatible with pancreatic cancer. The postoperative course was uneventful and at present the patient was followed at outpatient clinic. To our knowledge, this case is the first report with pancreatic cancer associated with the sign of Leser-Trelat in Japan.
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10.) The sign of Leser-Trelat: a cutaneous sign of internal malignancy:weakened subepithelial matrix from the effect of neoplasms on the extracellular matrix of the host.
===========================================================
Med Hypotheses 1993 Jun;40(6):360-3
Stone OJ
The sudden onset of many seborrheic keratoses (SK) associated with an internal malignancy (most commonly adenocarcinoma) is called the sign of Leser-Trelat. It is associated with acanthosis nigricans (AN) in 20% of the cases. There are marked changes in the extracellular matrix (ECM)around tumors. Various fractions and depolymerized glycosaminoglycans enter circulation. They can incorporate in the general extracellular matrix. Mechanical factors present in AN produce extrusions of this poor quality ECM in the form of papillae and folds. The poor quality of subepithelial extracellular matrix produces the marked epithelial changes of acanthosis nigricans which shows hyperkeratosis,papillomatosis, slight irregular acanthosis, and keratin material formation. The neoplasm can produce the same qualitative changes in the subepithelial ECM on otherwise normal appearing skin. When the altered same epithelial changes occur on this biologically altered skin the result is many SK (the sign of Leser-Trelat).
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11.) [Skin manifestation of internal malignancy].
===========================================================
Gan To Kagaku Ryoho 1991 Mar;18(3):365-70 Related Articles, Books
Nishiyama S
Department of Dermatology, School of Medicine, Kitasato University,
Sagamihara, Japan.
Relationship between malignant tumor of the internal organ and the skin can be classified as skin metastasis of the malignant tumor,non-specific skin manifestation of the malignant tumor and hereditary syndrome which tends to have malignant tumor. I, however, discuss here
mainly about the non-specific manifestation of the malignant tumor by showing representative cases of the dermadrome. Such cases are acanthosis nigricans, Leser-Trelat's sign, dermatomyositis, atypical erythema, acquired ichthyosis, Sweet's disease, Weber-Christian's syndrome, phlebitis migrans and Bazex syndrome.
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12.) Leser-Trelat sign associated with Sezary syndrome.
===========================================================
SO - J Dermatol 1995 Jan;22(1):62-7
AU - Ikari Y; Ohkura M; Morita M; Seki K; Kubota Y; Mizoguchi M
PT - JOURNAL ARTICLEAB
- A 74-year-old Japanese male had developed generalized erythrodermaand rapid growth of multiple verrucous lesions over the entire surfaceof his face, trunk, and extremities three months before he was seen. Histologically seborrheic keratoses were revealed. Laboratoryexaminations showed peripheral leukocytosis with atypical lymphocytesand high levels of IgE and IgG. On the basis of these clinical andhistopathologic findings, we diagnosed the patient as havingLeser-Trelat sign associated with Sezary syndrome. The erythrodermasubsided after administration of oral predonisone, and no new formationsof seborrheic keratosis were observed. However, because of subsequentaggravation of the generalized erythroderma, we administered chemotherapy. Six months after the initial examination, lung cancer wasfound, and the patient subsequently died of respiratory and renalfailure.
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13.) The sign of Leser-Trelat associated with transitional cellcarcinoma of the urinary-bladder--a case report and short review.
===========================================================
SO - Clin Exp Dermatol 1994 Mar;19(2):142-5
AU - Yaniv R; Servadio Y; Feinstein A; Trau H
PT - JOURNAL ARTICLE; REVIEW (28 references);
REVIEW OF REPORTED CASES
AB - Leser-Trelat sign is defined as the sudden appearance of multipleseborrhoeic keratoses in association with internal malignancy. Although75 cases have been reported to date, controversy still exists about thesignificance of this sign. The first association of the Leser-Trelatsign with transitional cell carcinoma of the urinary-bladder isreported.
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14.) Mycosis fungoides with Leser-Trelat sign: the first report of apatient from Japan.
===========================================================
SO - J Dermatol 1994 Mar;21(3):189-93
AU - Miyako F; Dekio S; Tamura H; Yamada Y; Miyata N; Jidoi J; Tohgi KPT - JOURNAL ARTICLEAB -
We describe here a 35-year-old Japanese woman with mycosisfungoides (MF) who developed numerous, rapidly-growing, seborrheic keratoses on the front of her neck and chest. To the best of ourknowledge, this is the first reported case of MF with Leser-Trelat signfrom Japan.
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15.) The sign of Leser-Trelat associated with adenocarcinoma of the rectum.
===========================================================
SO - Cutis 1993 Apr;51(4):255-7
AU - Cohn MS; Classen RF
PT - JOURNAL ARTICLE
AB - The authors report a case of the sign of Leser-Trelat occurring ina patient with primary adenocarcinoma of the rectum. The patient demonstrated the sign several months before the internal malignancy wasdiscovered. Although the majority of patients with the sign have anunderlying adenocarcinoma of the gastrointestinal tract, relatively fewcases have been reported with the rectum as the primary site. This casedemonstrates a classic example of the sign of Leser-Trelat andillustrates its importance as a marker of underlying malignancy. ===========================================================
16.) Seborrheic keratoses and cancer.
===========================================================
SO - J Am Acad Dermatol 1992 Jun;26(6):947-50
AU - Lindelof B; Sigurgeirsson B; Melander S
PT - JOURNAL ARTICLE
AB - BACKGROUND:
The eruptive appearance of numerous seborrheickeratoses, the sign of Leser-Trelat, has been regarded as a reliable cutaneous marker of internal malignancy.
OBJECTIVE:
We have evaluatedthe possible association of malignant disease and the sign in 1752consecutive cases of seborrheic keratoses.
METHODS:
First, the SwedishCancer Registry was searched for records of malignancies in the studypopulation (1958 to 1984), and the expected number of malignancies was calculated. Second, records of persons with malignancy within 1 yearbefore or after the diagnosis of seborrheic keratosis were checked forthe sign of Leser-Trelat. Third, a case control study was performed toevaluate the possibility of eruptive seborrheic keratoses among thenoncancer patients in the study population.
RESULTS:
The results showeda slight increased risk of cancer in the study population (relative risk= 1.2; 95% confidence interval = 1.0 to 1.3), mainly because of anincreased risk of cutaneous squamous cell carcinoma. In 62 patients with seborrheic keratoses, a malignancy (excluding skin) was diagnosed within1 year before or after the diagnosis of seborrheic keratosis. Of these62 patients, 6 were regarded as possibly having presented with the signof Leser-Trelat. For every one of the 62 cases with seborrheic keratosisand malignancy within one year, an age- and sex-matched control patient without cancer was selected from the study population and the recordswere checked for sudden and eruptive seborrheic keratoses. Among thecontrol patients, five were regarded as possibly having presented withthe sign of Leser-Trelat.
CONCLUSION: This study gives no evidence tosupport the opinion that eruptive seborrheic keratoses are related to internal cancer risk.
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17.) The sign of Leser-Trelat in a young woman with
osteogenic sarcoma.
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SO - J Am Acad Dermatol 1992 Feb;26(2 Pt 2):344-7
AU - Barron LA; Prendiville JS
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat refers to a sudden increase in size and number of seborrheic keratoses associated with internal malignancy. Thevalidity of this cutaneous sign continues to be debated, particularlybecause of the prevalence of both seborrheic keratoses and malignancy inthe elderly population. Preceding inflammatory skin conditions are knownto precipitate eruptions of seborrheic keratoses in otherwise healthy persons. These cutaneous lesions may also be associated with othermarkers of underlying malignancy such as acanthosis nigricans. Wepresent a young female patient with osteogenic sarcoma in whom eruptive seborrheic keratoses developed. We believe this case is representativeof the sign of Leser-Trelat.
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18.) Sign of Leser-Trelat with a metastatic mucinous adenocarcinoma.
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SO - Cutis 1991 Apr;47(4):258-60
AU - Schwartz RA; Helmold ME; Janniger CK; Gascon P
PT - JOURNAL ARTICLE
AB - We describe a middle-aged woman with the sudden onset of multiple seborrheic keratoses in association with a metastatic mucinousadenocarcinoma to the liver from an unknown primary neoplasm. This caseillustrates the significance of the sign of Leser-Trelat and its association with cancer.
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19.) The sign of Leser-Trelat: does it exist? [see
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comments]SO - J Am Acad Dermatol 1989 Jul;21(1):50-5AU - Rampen HJ; Schwengle LEPT - JOURNAL ARTICLE; REVIEW (51 references);
REVIEW OF REPORTED CASESAB - The sign of Leser-Trelat is usually regarded as a reliable cutaneous marker of internal malignancy. We have reviewed the literatureand conclude that the evidence for a causal relation between eruptive seborrheic keratoses and cancer is meager.
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20.) The sign of Leser-Trelat associated with malignant melanoma.
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SO - Cutis 1989 Jul;44(1):39-41
AU - Fanti PA; Metri M; Patrizi A
PT - JOURNAL ARTICLEAB -
A case of the sudden appearance of multiple pruritic seborrheickeratoses (Leser-Trelat sign) associated with cutaneous malignant melanoma is reported. To the authors' knowledge, this association hasnot been previously reported.
=========================================================== 21.) Paraneoplastic rhinophyma and the Leser-Trelat sign. ===========================================================
SO - Clin Exp Dermatol 1989 May;14(3):253-5AU - Mayou SC; Benn JJ; Sonksen PH; Black MMPT -
JOURNAL ARTICLE
AB - A case of the Leser-Trelat sign associated with an underlyingmalignant haemangiopericytoma is described. In addition, the patient hadprofound hypoglycaemia and a rhinophyma-like nasal swelling which rapidly resolved post-operatively.
The tumour appeared to be secreting afactor(s) which cross-reacted with both insulin receptors to induce hypoglycaemia and epidermal growth factor receptors inducing a profusionof eruptive seborrhoeic warts. It aslo had marked sebotrophic activity.The association of the Leser-Trelat sign with malignant haemangiopericytoma has not previously been described.
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22.) Transformation of lymphocytoma cutis into a malignant lymphoma inassociation with the sign of Leser-Trelat.
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SO - Acta Derm Venereol 1987;67(2):172-5
AU - Halevy S; Sandbank MPT - JOURNAL ARTICLEAB - A patient is described in whom transformation of lymphocytomacutis (LC) into malignant lymphoma, diffuse, mixed small and large lymphocytes, occurred in association with the sign of Leser-Trelat (LT),which is a marker for internal malignancy. To the best of our knowledge,such an association has not been reported previously.
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23.) Leser-Trelat sign associated with Sezary syndrome.
===========================================================
SO - Cutis 1985 Nov;36(5):409-10
AU - Horiuchi Y; Katsuoka K; Tsukamoto K; Takezaki SPT - JOURNAL ARTICLEAB - The Leser-Trelat sign is a rare but well known cutaneous indicatorof internal malignancy, most commonly adenocarcinoma of the stomach.There have been only a few cases associated with lymphoproliferativemalignancies. Sezary syndrome is a chronic leukemia/lymphoma characterized by generalized erythroderma and circulating Sezary cells.We describe a rare case of the Leser-Trelat sign associated with theSezary syndrome. The skin sign was alleviated through combinationchemotherapy.
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24.) The sign of Leser-Trelat associated with primary lymphoma of thebrain.
===========================================================
SO - Cutis 1984 Aug;34(2):164-5
AU - Kaplan DL; Jegasothy B
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat has been defined as the sudden appearanceof seborrheic keratoses in number and/or size in association with anunderlying malignancy. There have been only thirty-two reported cases ofthe sign of Leser-Trelat since it was first described in 1984. This isthe first known case of primary lymphoma of the brain associated withthis sign. Until Dantzig's review of the literature in 1973, the onlytumor type associated with this sign had been adenocarcinomas of thegastrointestinal tract and the genitourinary tract. Since that timethere have been only nine cases reported that were not adenocarcinomas;of those, only four cases have been lymphoproliferative malignancies. Wewish to emphasize the need for further reports of this sign to bettercharacterize it and to make physicians more aware of the associationbetween this dermatologic sign and an internal malignancy.
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25.) Acanthosis nigricans and the sign of Leser-Trelat associated withadenocarcinoma of the gallbladder.
===========================================================
SO - Cancer 1981 Jul 15;48(2):325-8
AU - Jacobs MI; Rigel DS
PT - JOURNAL ARTICLE
AB - A case of adenocarcinoma of the gallbladder associated withacanthosis nigricans and the sign of Leser-Trelat is presented. The significant underrepresentation of adenocarcinoma of the gallbladder inassociation with malignant acanthosis nigricans is noted. If malignantacanthosis nigricans is caused by an ectopic peptide, a relative lack ofproduction of the postulated substance by gallbladder adenocarcinomacells could account for this finding.
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26.) Bile duct adenocarcinoma with Leser-Trelat sign and pure red bloodcell aplasia.
===========================================================
SO - Cancer 1980 Oct 1;46(7):1657-60
AU - Lee CH; Clark AR; Thorpe ME; Mackie BS; Firkin FC
PT - JOURNAL ARTICLE
AB - A case of adenocarcinoma of the bile duct complicating longstanding ulcerative colitis and associated with the rapid onset andgrowth of multiple seborrheic keratosis (Leser-Trelat sign) and pure redblood cell aplasia is described. This is the first report of a case ofthe coexistence of the Leser-Trelat sign and pure red blood cell aplasiain a patient with a malignancy. Both manifestations have been doubted as truly paraneoplastic manifestations because of their rarity in clinicalmedicine. Their co-existence in the present case would support theirassociaton with malignancy.
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27.) The sign of Leser-Trelat. Report of a case with adenocarcinoma ofthe duodenum.
===========================================================
SO - Arch Dermatol 1980 Sep;116(9):1059-60
AU - Curry SS; King LE
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat is a rare cutaneous manifestation of internal malignancy. Although adenocarcinoma is the most commonmalignant neoplasm associated with the sign of Leser-Trelat, we reportwhat we believe to be the first case of adenocarcinoma of the duodenum associated with this sign. Because of the location of the tumor, weconsidered the possibility that the skin changes may be due to increasedlevels of epidermal growth factor (EGF) in this patient. However, noalteration in urine EGF levels was found.
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28.) [The Leser-Trelat symptom: report of two cases
===========================================================
(author's transl)]
SO - Ann Dermatol Venereol 1980;107(11):1035-41
AU - Lambert D; Fort M; Legoux A; Chapuis JL
MC - English AbstractPT -
JOURNAL ARTICLE; REVIEW (22 references)
AB - The sudden occurrence and rapid increase in size and number ofseborrheic keratoses is considered to be a symptom of internal malignancy. But many authors did not fully agree with this finding. Wereport two cases respectively associated, the first with a mycosisfongoides, the second with a bronchial squamous cell carcinoma. These
observations are compared with thin cases previously published in thedermatological literature (13 patients). According to Dantzig thecommonest associated malignancy is an adenocarcinoma, and the most frequent site the stomach. But there are also report of acute leukemia,mycosis fongoides, Sezary and lymphocytic lymphoma. The mechanism of the simultaneous growth of the lesions remains unknown and may be purelycoincidental. Other case reports and several criteria still to bedefined are needed before we accept this symptom as a malignancy marker.
===========================================================
29.) Adenocarcinoma of the stomach with eruptive seborrheic keratoses:the sign of Leserp-Trelat.
===========================================================
SO - Cancer 1980 May 1;45(9):2434-7
AU - Sperry K; Wall J
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat, the sudden appearance of multipleseborrheic keratoses in conjunction with an internal malignancy, is very uncommon. A case involving a patient who had undergone resection of anadenocarcinoma of the sigmoid colon followed ten years later by thedevelopment of an adenocarcinoma of the stomach with exhibition of the sign of Leser-Trelat is presented. A summary of reported cases, alongwith a discussion of the sign, is provided. This is the first reportedcase of a patient presenting with the sign of Leser-Trelat along with asecond primary malignancy.
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30.) Florid cutaneous papillomatosis, malignant acanthosis nigricans,and pulmonary squamous cell carcinoma.
===========================================================
SO - Int J Dermatol 1991 Mar;30(3):193-7
AU - Gheeraert P; Goens J; Schwartz RA; Lambert WC; Schroeder F;
Debusscher L
PT - JOURNAL ARTICLE; REVIEW (25 references);
REVIEW OF REPORTED CASES
AB - A 72-year-old man had florid cutaneous papillomatosis (FCP), whichis an obligatory paraneoplastic syndrome always associated with aninternal malignancy. The cancer, which is usually intraabdominal andmost often gastric in origin, evolves parallel to the FCP. This patientis the first case of FCP occurring in association with a lungmalignancy. An association of FCP with other signs of internal cancer iscommon, with malignant acanthosis nigricans usually appearing many times with the sign of Leser-Trelat. FCP, malignant acanthosis nigricans, andthe sign of Leser-Trelat are part of a continuum, developing by a commonor similar pathogenic pathway due to an underlying malignancy producinga factor possibly similar to human epidermal growth factor.
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31.) The relation between seborrheic keratoses and malignant solidtumours. A case-control study.
===========================================================
SO - Acta Derm Venereol 1991;71(2):166-9
AU - Grob JJ; Rava MC; Gouvernet J; Fuentes P; Piana L; Gamerre M;Sarles JC; Bonerandi JJPT -
JOURNAL ARTICLE
AB - In order to establish whether or not here is an associationbetween cancer and intense growth of seborrheic keratosis, the so-calledLeser-Trelat sign, we conducted a case control study in which the numberand features of seborrheic keratosis in 82 patients with recent solid
tumours, were compared with 82 age- and sex-matched controls. Neithernumbers nor features of seborrheic keratosis differed significantly inpatients and controls. Eruptive seborrheic keratosis was noted in onlyone patient and one control. This study showed that solid malignanciesare not generally associated with an increase in the number or size ofseborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Ourresults suggest that Leser-Trelat is either a coincidence, or at most avery rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, arenot regularly associated with solid tumours.
===========================================================
32.) Transformation of Sezary syndrome and the sign of Leser-Trelat: ahistopathologic study.
===========================================================
SO - J Am Acad Dermatol 1990 Sep;23(3 Pt 1):520-2
AU - Wieselthier JS; Bhawan J; Koh HK
PT - JOURNAL ARTICLE
===========================================================
33.) Sign of Leser-Trelat: report of two cases and review of the
literature.
===========================================================
SO - J Am Acad Dermatol 1984 Jan;10(1):83-8
AU - Venencie PY; Perry HO
PT - JOURNAL ARTICLE
AB - The sudden appearance of multiple seborrheic keratoses in the two
patients could be related to adenocarcinoma of the breast. Despite other
isolated reports, this disorder is still controversial as a marker of
malignancy.
===========================================================
34.) Pemphigus foliaceus resembling eruptive seborrheic keratoses.
===========================================================
SO - Arch Dermatol 1980 Jul;116(7):815-6
AU - Bruckner N; Katz RA; Hood AF
PT - JOURNAL ARTICLEAB - A 78-year-old man had an acute eruption of lesions that clinically resembled seborrheic keratoses. Microscopic examination of the lesionsindicated acantholysis and dyskeratosis primarily in the granular layer.The patient's serum contained antibodies to intercellular substance.Direct immunofluorescence microscopy of a lesion demonstratedimmunoglobulin deposition in the intercellular areas. Treatment withoral prednisone produced rapid resolution of the lesions. Patients in whom eruptive seborrheic keratoses (Leser-Trelat sign) develop shouldhave histological examination of their lesions to rule out the diagnosisof pemphigus foliaceus.
===========================================================
35.) Eruptive seborrheic keratoses in a young woman with acromegaly.
===========================================================
SO - J Am Acad Dermatol 1990 Nov;23(5 Pt 2):991-4
AU - Kilmer SL; Berman B; Morhenn VB
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat, or eruptive seborrheic keratoses, is purported to be a cutaneous marker for many underlying malignancies.Elevation in levels of growth factors has been postulated to be the stimulus for the sudden eruption of multiple new seborrheic keratoses.In support of this hypothesis we present a case of eruptive seborrheickeratoses in a young woman with acromegaly and elevated levels of growthhormone.
===========================================================
36.) Seborrheic keratosis and papillomatosis: markers of breastadenocarcinoma.
===========================================================
SO - Cutis 1983 Aug;32(2):161-2
AU - Friedman-Birnbaum R; Haim S
PT - JOURNAL ARTICLEAB -
Seborrheic keratosis (Leser-Trelat sign) and extensive florid papillomatosis of the skin and the mucous membranes of the nose, mouth,throat, and external genitalia were associated with adenocarcinoma ofthe breast in a 61-year-old woman.
===========================================================
37.) A case of hepatocellular carcinoma with the sign of Leser-Trelat: apossible role of a cutaneous marker for internal malignancy.
===========================================================
Jpn J Med 1991 Jan-Feb;30(1):53-6 Related Articles, Books, LinkOut
Tajima H, Mitsuoka S, Ohtsuka E, Nakamura Y, Nakayama T, Satoh Y, Shima M, Nakata K, Kusumoto Y, Koji T, et al
First Department of Internal Medicine, Nagasaki University School of
Medicine, Japan.
A rare case of hepatocellular carcinoma who developed the complication of the sign of Leser-Trelat is reported. The patient, a 57-year-oldmale, visited our hospital with complaints of generalized malaise andanorexia. A diagnosis of hepatocellular carcinoma was made based onelevated alpha-fetoprotein measurement, ultrasonography, and hepaticarteriography findings. Chest x-ray film suggested pulmonary metastasesof hepatocellular carcinoma. Thereafter, complications of the seborrheickeratosis developed in the trunk and the skin lesion was diagnosed asthe sign of Leser-Trelat associated with hepatocellular carcinoma. Thepatient died of pneumonia 9 months after development of the sign ofLeser-Trelat.
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38.) the relation between seborrheic keratoses and malignant solidtumours. A case-control study.
===========================================================
Acta Derm Venereol 1991;71(2):166-9 Related Articles, Books
Grob JJ, Rava MC, Gouvernet J, Fuentes P, Piana L, Gamerre M, Sarles JC,
Bonerandi JJ
Service de Dermatologie, Hopital Ste Marguerite, Marseille, France.
In order to establish whether or not here is an association between cancer and intense growth of seborrheic keratosis, the so-calledLeser-Trelat sign, we conducted a case control study in which the numberand features of seborrheic keratosis in 82 patients with recent solid tumours, were compared with 82 age- and sex-matched controls. Neithernumbers nor features of seborrheic keratosis differed significantly inpatients and controls. Eruptive seborrheic keratosis was noted in onlyone patient and one control.
This study showed that solid malignanciesare not generally associated with an increase in the number or size ofseborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Ourresults suggest that Leser-Trelat is either a coincidence, or at most avery rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, arenot regularly associated with solid tumours.
===========================================================
39.) [Useful cutaneous markers of internal malignancy in the earlystage].
===========================================================
Gan To Kagaku Ryoho 1988 Apr;15(4 Pt 2-3):1564-8 Related Articles, Books
Mori S
Dept. of Dermatology, Gifu University School of Medicine.
Numerous skin changes are correlated with internal malignancy. These skin changes are collectively called dermadromes of internal malignancyor syndroma dermato-tumorale. The skin markers of internal malignancycan be classified into
1) skin metastasis,
2) paraneoplastic dermatoses,
3) cutaneous manifestations of the systemic carcinogenic disease processand
4) cancer-malformation syndrome.
For diagnosis of the early stage ofinternal malignancy, paraneoplastic dermatoses are the most importantamong other skin changes. Above all, dermatomyositis, figurate erythemas, erythroderma and a number of bullous dermatoses (e.g.,bullous pemphigoid, pemphigus vulgaris and dermatitis herpetiformis,Sweet' syndrome, pruritus, prurigo, acanthosis nigricans, Leser-Trelatsign, alopecia mucinosa, acquired ichthyosis, Bazex' syndrome,hypertrichosis aquisita lanuginosa) are among the paraneoplasticdermatoses.
A total of 405 cases of syndroma dermato-tumorale except cases of skin metastasis were reported for recent 7 years (1980-1986)only in the dermatological field in Japan. Among them, cases ofparaneoplastic dermatoses number 354 accounting for the majority. Finally, brief consideration is given to the relationship between theabove mentioned skin manifestations and internal malignancy.
===========================================================
40.) [Gastrointestinal carcinoma with skin diseases from the standpointof surgery].
===========================================================
Gan To Kagaku Ryoho 1988 Apr;15(4 Pt 2-3):1560-3 Related Articles, Books
Nishidoi H, Koga S, Kanbe N
1st Dept. of Surgery, Tottori University School of Medicine.
We encountered 21 patients with gastrointestinal carcinoma accompanied with skin diseases such as acanthosis nigricans, dermatomyositis,pemphigoid, erythrodermia, ichthyosis vulgaris, herpes zoster,Leser-Trelat's sign, Recklinghausen's disease and Gardner's syndrome. Wehave discussed such cases from the standpoint of surgery. There were 16cases (76%) with gastric carcinoma, which were almost in the faradvanced stage. Carcinomas of the other patients were seen in the esophagus, liver, pancreas, small intestine and rectum. Although skinlesions appeared before the onset of gastrointestinal symptoms in almostall cases, detection of carcinomas was very difficult until the symptomsemerged. In 6 of 21 patients (29%), carcinomas were detected by onlyskin manifestation, and they proved to be gastric cancer in all cases. Although the relationship of gastrointestinal carcinoma and skindiseases was unclear, we presented a 70-year-old woman with acanthosisnigricans accompanied with gastric cancer, whose skin manifestation wasreduced by the therapy for gastric cancer. Therefore, some of these skinmanifestation may be a symptom of the biological characteristics of thegastrointestinal carcinoma.
===========================================================
41.) [Leser-Trelat sign in adenocarcinoma of the sigmoid colon--a rareclinical picture].
===========================================================
Z Hautkr 1987 Jun 1;62(11):875-6 Related Articles, Books
Hodak E, Halevy S, Ingber A, Engelstein D, Sandbank M
We report on a 75-year-old man showing the very rare association of Leser-Trelat's sign and adenocarcinoma of the sigmoid colon. Our case isthe second one reported so far.
===========================================================
42.) [Acanthosis nigricans maligna and Leser-Trelat sign in doublemalignancy of the breast and stomach].
===========================================================
Z Hautkr 1987 Mar 1;62(5):344-66 Related Articles, Books
Stieler W, Plewig G
A female patient with primary cancer of the breast and the stomach developed acanthosis nigricans maligna and Leser-Trelat's sign.Acanthosis nigricans maligna is a well-known cutaneous marker ofinternal malignancy. It may be intensified by radiotherapy. A variant is called florid cutaneous papillomatosis. Leser-Trelat's sign is a rarecutaneous marker of internal neoplasms. According to the literature, wepresent 46 patients showing Leser-Trelat's sign. Neither Leser norTrelat described this sign. ===================================================================
43.) Beitrage Zur Fruhdiagnose des darmcarcinoms (Hereditasverhaltnisse und Hautveranderungen) hollander E
Dtsch Med Woschenschr 1900;26:483-5
===================================================================
J Urol 1993 Oct;150(4):1246-50 Related Articles, Books
Martin RW 3d, Rady P, Arany I, Tyring SK
Department of Dermatology, Johns Hopkins School of Medicine, Baltimore,Maryland.
We present a case of a benign testicular Leydig cell tumor and eruptive seborrheic keratosis associated with human papillomavirus type 33infection. To our knowledge this is the first occurrence of a Leydig Cell tumor in a patient with tuberous sclerosis and the second documented case of eruptive seborrheic keratoses (sign of Leser-Trelat)associated with a benign neoplasm.
===========================================================
9.) A case of pancreatic cancer with the sign of Leser-Trelat.
===========================================================
Nippon Geka Hokan 1993 Jul 1;62(4):203-8 Related Articles, Books
Hirano T, Yoshioka H, Manabe T
Department of Surgery, Yoshioka Hospital, Kyoto, Japan.
A case of 79-year-old man with pancreatic cancer associated with the sign of Leser-Trelat was presented. Abdominal CT scanning was performed and a pancreatic tail tumor involving the spleen and the greater omentum as well as ascitic retention were detected. Ba-enema study showed the stenosis of the sigmoid colon, suggesting the peritoneal disseminations.Absolute non-curative operation of side-to-side transverso-sigmoidostomy was performed for colonic stenosis, and biopsy of the disseminated omental tumor was performed, which was histologically diagnosed as well differentiated papillary adenocarcinoma compatible with pancreatic cancer. The postoperative course was uneventful and at present the patient was followed at outpatient clinic. To our knowledge, this case is the first report with pancreatic cancer associated with the sign of Leser-Trelat in Japan.
===========================================================
10.) The sign of Leser-Trelat: a cutaneous sign of internal malignancy:weakened subepithelial matrix from the effect of neoplasms on the extracellular matrix of the host.
===========================================================
Med Hypotheses 1993 Jun;40(6):360-3
Stone OJ
The sudden onset of many seborrheic keratoses (SK) associated with an internal malignancy (most commonly adenocarcinoma) is called the sign of Leser-Trelat. It is associated with acanthosis nigricans (AN) in 20% of the cases. There are marked changes in the extracellular matrix (ECM)around tumors. Various fractions and depolymerized glycosaminoglycans enter circulation. They can incorporate in the general extracellular matrix. Mechanical factors present in AN produce extrusions of this poor quality ECM in the form of papillae and folds. The poor quality of subepithelial extracellular matrix produces the marked epithelial changes of acanthosis nigricans which shows hyperkeratosis,papillomatosis, slight irregular acanthosis, and keratin material formation. The neoplasm can produce the same qualitative changes in the subepithelial ECM on otherwise normal appearing skin. When the altered same epithelial changes occur on this biologically altered skin the result is many SK (the sign of Leser-Trelat).
===========================================================
11.) [Skin manifestation of internal malignancy].
===========================================================
Gan To Kagaku Ryoho 1991 Mar;18(3):365-70 Related Articles, Books
Nishiyama S
Department of Dermatology, School of Medicine, Kitasato University,
Sagamihara, Japan.
Relationship between malignant tumor of the internal organ and the skin can be classified as skin metastasis of the malignant tumor,non-specific skin manifestation of the malignant tumor and hereditary syndrome which tends to have malignant tumor. I, however, discuss here
mainly about the non-specific manifestation of the malignant tumor by showing representative cases of the dermadrome. Such cases are acanthosis nigricans, Leser-Trelat's sign, dermatomyositis, atypical erythema, acquired ichthyosis, Sweet's disease, Weber-Christian's syndrome, phlebitis migrans and Bazex syndrome.
===========================================================
12.) Leser-Trelat sign associated with Sezary syndrome.
===========================================================
SO - J Dermatol 1995 Jan;22(1):62-7
AU - Ikari Y; Ohkura M; Morita M; Seki K; Kubota Y; Mizoguchi M
PT - JOURNAL ARTICLEAB
- A 74-year-old Japanese male had developed generalized erythrodermaand rapid growth of multiple verrucous lesions over the entire surfaceof his face, trunk, and extremities three months before he was seen. Histologically seborrheic keratoses were revealed. Laboratoryexaminations showed peripheral leukocytosis with atypical lymphocytesand high levels of IgE and IgG. On the basis of these clinical andhistopathologic findings, we diagnosed the patient as havingLeser-Trelat sign associated with Sezary syndrome. The erythrodermasubsided after administration of oral predonisone, and no new formationsof seborrheic keratosis were observed. However, because of subsequentaggravation of the generalized erythroderma, we administered chemotherapy. Six months after the initial examination, lung cancer wasfound, and the patient subsequently died of respiratory and renalfailure.
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13.) The sign of Leser-Trelat associated with transitional cellcarcinoma of the urinary-bladder--a case report and short review.
===========================================================
SO - Clin Exp Dermatol 1994 Mar;19(2):142-5
AU - Yaniv R; Servadio Y; Feinstein A; Trau H
PT - JOURNAL ARTICLE; REVIEW (28 references);
REVIEW OF REPORTED CASES
AB - Leser-Trelat sign is defined as the sudden appearance of multipleseborrhoeic keratoses in association with internal malignancy. Although75 cases have been reported to date, controversy still exists about thesignificance of this sign. The first association of the Leser-Trelatsign with transitional cell carcinoma of the urinary-bladder isreported.
===========================================================
14.) Mycosis fungoides with Leser-Trelat sign: the first report of apatient from Japan.
===========================================================
SO - J Dermatol 1994 Mar;21(3):189-93
AU - Miyako F; Dekio S; Tamura H; Yamada Y; Miyata N; Jidoi J; Tohgi KPT - JOURNAL ARTICLEAB -
We describe here a 35-year-old Japanese woman with mycosisfungoides (MF) who developed numerous, rapidly-growing, seborrheic keratoses on the front of her neck and chest. To the best of ourknowledge, this is the first reported case of MF with Leser-Trelat signfrom Japan.
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15.) The sign of Leser-Trelat associated with adenocarcinoma of the rectum.
===========================================================
SO - Cutis 1993 Apr;51(4):255-7
AU - Cohn MS; Classen RF
PT - JOURNAL ARTICLE
AB - The authors report a case of the sign of Leser-Trelat occurring ina patient with primary adenocarcinoma of the rectum. The patient demonstrated the sign several months before the internal malignancy wasdiscovered. Although the majority of patients with the sign have anunderlying adenocarcinoma of the gastrointestinal tract, relatively fewcases have been reported with the rectum as the primary site. This casedemonstrates a classic example of the sign of Leser-Trelat andillustrates its importance as a marker of underlying malignancy. ===========================================================
16.) Seborrheic keratoses and cancer.
===========================================================
SO - J Am Acad Dermatol 1992 Jun;26(6):947-50
AU - Lindelof B; Sigurgeirsson B; Melander S
PT - JOURNAL ARTICLE
AB - BACKGROUND:
The eruptive appearance of numerous seborrheickeratoses, the sign of Leser-Trelat, has been regarded as a reliable cutaneous marker of internal malignancy.
OBJECTIVE:
We have evaluatedthe possible association of malignant disease and the sign in 1752consecutive cases of seborrheic keratoses.
METHODS:
First, the SwedishCancer Registry was searched for records of malignancies in the studypopulation (1958 to 1984), and the expected number of malignancies was calculated. Second, records of persons with malignancy within 1 yearbefore or after the diagnosis of seborrheic keratosis were checked forthe sign of Leser-Trelat. Third, a case control study was performed toevaluate the possibility of eruptive seborrheic keratoses among thenoncancer patients in the study population.
RESULTS:
The results showeda slight increased risk of cancer in the study population (relative risk= 1.2; 95% confidence interval = 1.0 to 1.3), mainly because of anincreased risk of cutaneous squamous cell carcinoma. In 62 patients with seborrheic keratoses, a malignancy (excluding skin) was diagnosed within1 year before or after the diagnosis of seborrheic keratosis. Of these62 patients, 6 were regarded as possibly having presented with the signof Leser-Trelat. For every one of the 62 cases with seborrheic keratosisand malignancy within one year, an age- and sex-matched control patient without cancer was selected from the study population and the recordswere checked for sudden and eruptive seborrheic keratoses. Among thecontrol patients, five were regarded as possibly having presented withthe sign of Leser-Trelat.
CONCLUSION: This study gives no evidence tosupport the opinion that eruptive seborrheic keratoses are related to internal cancer risk.
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17.) The sign of Leser-Trelat in a young woman with
osteogenic sarcoma.
===========================================================
SO - J Am Acad Dermatol 1992 Feb;26(2 Pt 2):344-7
AU - Barron LA; Prendiville JS
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat refers to a sudden increase in size and number of seborrheic keratoses associated with internal malignancy. Thevalidity of this cutaneous sign continues to be debated, particularlybecause of the prevalence of both seborrheic keratoses and malignancy inthe elderly population. Preceding inflammatory skin conditions are knownto precipitate eruptions of seborrheic keratoses in otherwise healthy persons. These cutaneous lesions may also be associated with othermarkers of underlying malignancy such as acanthosis nigricans. Wepresent a young female patient with osteogenic sarcoma in whom eruptive seborrheic keratoses developed. We believe this case is representativeof the sign of Leser-Trelat.
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18.) Sign of Leser-Trelat with a metastatic mucinous adenocarcinoma.
===========================================================
SO - Cutis 1991 Apr;47(4):258-60
AU - Schwartz RA; Helmold ME; Janniger CK; Gascon P
PT - JOURNAL ARTICLE
AB - We describe a middle-aged woman with the sudden onset of multiple seborrheic keratoses in association with a metastatic mucinousadenocarcinoma to the liver from an unknown primary neoplasm. This caseillustrates the significance of the sign of Leser-Trelat and its association with cancer.
===========================================================
19.) The sign of Leser-Trelat: does it exist? [see
===========================================================
comments]SO - J Am Acad Dermatol 1989 Jul;21(1):50-5AU - Rampen HJ; Schwengle LEPT - JOURNAL ARTICLE; REVIEW (51 references);
REVIEW OF REPORTED CASESAB - The sign of Leser-Trelat is usually regarded as a reliable cutaneous marker of internal malignancy. We have reviewed the literatureand conclude that the evidence for a causal relation between eruptive seborrheic keratoses and cancer is meager.
===========================================================
20.) The sign of Leser-Trelat associated with malignant melanoma.
===========================================================
SO - Cutis 1989 Jul;44(1):39-41
AU - Fanti PA; Metri M; Patrizi A
PT - JOURNAL ARTICLEAB -
A case of the sudden appearance of multiple pruritic seborrheickeratoses (Leser-Trelat sign) associated with cutaneous malignant melanoma is reported. To the authors' knowledge, this association hasnot been previously reported.
=========================================================== 21.) Paraneoplastic rhinophyma and the Leser-Trelat sign. ===========================================================
SO - Clin Exp Dermatol 1989 May;14(3):253-5AU - Mayou SC; Benn JJ; Sonksen PH; Black MMPT -
JOURNAL ARTICLE
AB - A case of the Leser-Trelat sign associated with an underlyingmalignant haemangiopericytoma is described. In addition, the patient hadprofound hypoglycaemia and a rhinophyma-like nasal swelling which rapidly resolved post-operatively.
The tumour appeared to be secreting afactor(s) which cross-reacted with both insulin receptors to induce hypoglycaemia and epidermal growth factor receptors inducing a profusionof eruptive seborrhoeic warts. It aslo had marked sebotrophic activity.The association of the Leser-Trelat sign with malignant haemangiopericytoma has not previously been described.
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22.) Transformation of lymphocytoma cutis into a malignant lymphoma inassociation with the sign of Leser-Trelat.
===========================================================
SO - Acta Derm Venereol 1987;67(2):172-5
AU - Halevy S; Sandbank MPT - JOURNAL ARTICLEAB - A patient is described in whom transformation of lymphocytomacutis (LC) into malignant lymphoma, diffuse, mixed small and large lymphocytes, occurred in association with the sign of Leser-Trelat (LT),which is a marker for internal malignancy. To the best of our knowledge,such an association has not been reported previously.
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23.) Leser-Trelat sign associated with Sezary syndrome.
===========================================================
SO - Cutis 1985 Nov;36(5):409-10
AU - Horiuchi Y; Katsuoka K; Tsukamoto K; Takezaki SPT - JOURNAL ARTICLEAB - The Leser-Trelat sign is a rare but well known cutaneous indicatorof internal malignancy, most commonly adenocarcinoma of the stomach.There have been only a few cases associated with lymphoproliferativemalignancies. Sezary syndrome is a chronic leukemia/lymphoma characterized by generalized erythroderma and circulating Sezary cells.We describe a rare case of the Leser-Trelat sign associated with theSezary syndrome. The skin sign was alleviated through combinationchemotherapy.
===========================================================
24.) The sign of Leser-Trelat associated with primary lymphoma of thebrain.
===========================================================
SO - Cutis 1984 Aug;34(2):164-5
AU - Kaplan DL; Jegasothy B
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat has been defined as the sudden appearanceof seborrheic keratoses in number and/or size in association with anunderlying malignancy. There have been only thirty-two reported cases ofthe sign of Leser-Trelat since it was first described in 1984. This isthe first known case of primary lymphoma of the brain associated withthis sign. Until Dantzig's review of the literature in 1973, the onlytumor type associated with this sign had been adenocarcinomas of thegastrointestinal tract and the genitourinary tract. Since that timethere have been only nine cases reported that were not adenocarcinomas;of those, only four cases have been lymphoproliferative malignancies. Wewish to emphasize the need for further reports of this sign to bettercharacterize it and to make physicians more aware of the associationbetween this dermatologic sign and an internal malignancy.
===========================================================
25.) Acanthosis nigricans and the sign of Leser-Trelat associated withadenocarcinoma of the gallbladder.
===========================================================
SO - Cancer 1981 Jul 15;48(2):325-8
AU - Jacobs MI; Rigel DS
PT - JOURNAL ARTICLE
AB - A case of adenocarcinoma of the gallbladder associated withacanthosis nigricans and the sign of Leser-Trelat is presented. The significant underrepresentation of adenocarcinoma of the gallbladder inassociation with malignant acanthosis nigricans is noted. If malignantacanthosis nigricans is caused by an ectopic peptide, a relative lack ofproduction of the postulated substance by gallbladder adenocarcinomacells could account for this finding.
===========================================================
26.) Bile duct adenocarcinoma with Leser-Trelat sign and pure red bloodcell aplasia.
===========================================================
SO - Cancer 1980 Oct 1;46(7):1657-60
AU - Lee CH; Clark AR; Thorpe ME; Mackie BS; Firkin FC
PT - JOURNAL ARTICLE
AB - A case of adenocarcinoma of the bile duct complicating longstanding ulcerative colitis and associated with the rapid onset andgrowth of multiple seborrheic keratosis (Leser-Trelat sign) and pure redblood cell aplasia is described. This is the first report of a case ofthe coexistence of the Leser-Trelat sign and pure red blood cell aplasiain a patient with a malignancy. Both manifestations have been doubted as truly paraneoplastic manifestations because of their rarity in clinicalmedicine. Their co-existence in the present case would support theirassociaton with malignancy.
===========================================================
27.) The sign of Leser-Trelat. Report of a case with adenocarcinoma ofthe duodenum.
===========================================================
SO - Arch Dermatol 1980 Sep;116(9):1059-60
AU - Curry SS; King LE
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat is a rare cutaneous manifestation of internal malignancy. Although adenocarcinoma is the most commonmalignant neoplasm associated with the sign of Leser-Trelat, we reportwhat we believe to be the first case of adenocarcinoma of the duodenum associated with this sign. Because of the location of the tumor, weconsidered the possibility that the skin changes may be due to increasedlevels of epidermal growth factor (EGF) in this patient. However, noalteration in urine EGF levels was found.
===========================================================
28.) [The Leser-Trelat symptom: report of two cases
===========================================================
(author's transl)]
SO - Ann Dermatol Venereol 1980;107(11):1035-41
AU - Lambert D; Fort M; Legoux A; Chapuis JL
MC - English AbstractPT -
JOURNAL ARTICLE; REVIEW (22 references)
AB - The sudden occurrence and rapid increase in size and number ofseborrheic keratoses is considered to be a symptom of internal malignancy. But many authors did not fully agree with this finding. Wereport two cases respectively associated, the first with a mycosisfongoides, the second with a bronchial squamous cell carcinoma. These
observations are compared with thin cases previously published in thedermatological literature (13 patients). According to Dantzig thecommonest associated malignancy is an adenocarcinoma, and the most frequent site the stomach. But there are also report of acute leukemia,mycosis fongoides, Sezary and lymphocytic lymphoma. The mechanism of the simultaneous growth of the lesions remains unknown and may be purelycoincidental. Other case reports and several criteria still to bedefined are needed before we accept this symptom as a malignancy marker.
===========================================================
29.) Adenocarcinoma of the stomach with eruptive seborrheic keratoses:the sign of Leserp-Trelat.
===========================================================
SO - Cancer 1980 May 1;45(9):2434-7
AU - Sperry K; Wall J
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat, the sudden appearance of multipleseborrheic keratoses in conjunction with an internal malignancy, is very uncommon. A case involving a patient who had undergone resection of anadenocarcinoma of the sigmoid colon followed ten years later by thedevelopment of an adenocarcinoma of the stomach with exhibition of the sign of Leser-Trelat is presented. A summary of reported cases, alongwith a discussion of the sign, is provided. This is the first reportedcase of a patient presenting with the sign of Leser-Trelat along with asecond primary malignancy.
===========================================================
30.) Florid cutaneous papillomatosis, malignant acanthosis nigricans,and pulmonary squamous cell carcinoma.
===========================================================
SO - Int J Dermatol 1991 Mar;30(3):193-7
AU - Gheeraert P; Goens J; Schwartz RA; Lambert WC; Schroeder F;
Debusscher L
PT - JOURNAL ARTICLE; REVIEW (25 references);
REVIEW OF REPORTED CASES
AB - A 72-year-old man had florid cutaneous papillomatosis (FCP), whichis an obligatory paraneoplastic syndrome always associated with aninternal malignancy. The cancer, which is usually intraabdominal andmost often gastric in origin, evolves parallel to the FCP. This patientis the first case of FCP occurring in association with a lungmalignancy. An association of FCP with other signs of internal cancer iscommon, with malignant acanthosis nigricans usually appearing many times with the sign of Leser-Trelat. FCP, malignant acanthosis nigricans, andthe sign of Leser-Trelat are part of a continuum, developing by a commonor similar pathogenic pathway due to an underlying malignancy producinga factor possibly similar to human epidermal growth factor.
===========================================================
31.) The relation between seborrheic keratoses and malignant solidtumours. A case-control study.
===========================================================
SO - Acta Derm Venereol 1991;71(2):166-9
AU - Grob JJ; Rava MC; Gouvernet J; Fuentes P; Piana L; Gamerre M;Sarles JC; Bonerandi JJPT -
JOURNAL ARTICLE
AB - In order to establish whether or not here is an associationbetween cancer and intense growth of seborrheic keratosis, the so-calledLeser-Trelat sign, we conducted a case control study in which the numberand features of seborrheic keratosis in 82 patients with recent solid
tumours, were compared with 82 age- and sex-matched controls. Neithernumbers nor features of seborrheic keratosis differed significantly inpatients and controls. Eruptive seborrheic keratosis was noted in onlyone patient and one control. This study showed that solid malignanciesare not generally associated with an increase in the number or size ofseborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Ourresults suggest that Leser-Trelat is either a coincidence, or at most avery rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, arenot regularly associated with solid tumours.
===========================================================
32.) Transformation of Sezary syndrome and the sign of Leser-Trelat: ahistopathologic study.
===========================================================
SO - J Am Acad Dermatol 1990 Sep;23(3 Pt 1):520-2
AU - Wieselthier JS; Bhawan J; Koh HK
PT - JOURNAL ARTICLE
===========================================================
33.) Sign of Leser-Trelat: report of two cases and review of the
literature.
===========================================================
SO - J Am Acad Dermatol 1984 Jan;10(1):83-8
AU - Venencie PY; Perry HO
PT - JOURNAL ARTICLE
AB - The sudden appearance of multiple seborrheic keratoses in the two
patients could be related to adenocarcinoma of the breast. Despite other
isolated reports, this disorder is still controversial as a marker of
malignancy.
===========================================================
34.) Pemphigus foliaceus resembling eruptive seborrheic keratoses.
===========================================================
SO - Arch Dermatol 1980 Jul;116(7):815-6
AU - Bruckner N; Katz RA; Hood AF
PT - JOURNAL ARTICLEAB - A 78-year-old man had an acute eruption of lesions that clinically resembled seborrheic keratoses. Microscopic examination of the lesionsindicated acantholysis and dyskeratosis primarily in the granular layer.The patient's serum contained antibodies to intercellular substance.Direct immunofluorescence microscopy of a lesion demonstratedimmunoglobulin deposition in the intercellular areas. Treatment withoral prednisone produced rapid resolution of the lesions. Patients in whom eruptive seborrheic keratoses (Leser-Trelat sign) develop shouldhave histological examination of their lesions to rule out the diagnosisof pemphigus foliaceus.
===========================================================
35.) Eruptive seborrheic keratoses in a young woman with acromegaly.
===========================================================
SO - J Am Acad Dermatol 1990 Nov;23(5 Pt 2):991-4
AU - Kilmer SL; Berman B; Morhenn VB
PT - JOURNAL ARTICLE
AB - The sign of Leser-Trelat, or eruptive seborrheic keratoses, is purported to be a cutaneous marker for many underlying malignancies.Elevation in levels of growth factors has been postulated to be the stimulus for the sudden eruption of multiple new seborrheic keratoses.In support of this hypothesis we present a case of eruptive seborrheickeratoses in a young woman with acromegaly and elevated levels of growthhormone.
===========================================================
36.) Seborrheic keratosis and papillomatosis: markers of breastadenocarcinoma.
===========================================================
SO - Cutis 1983 Aug;32(2):161-2
AU - Friedman-Birnbaum R; Haim S
PT - JOURNAL ARTICLEAB -
Seborrheic keratosis (Leser-Trelat sign) and extensive florid papillomatosis of the skin and the mucous membranes of the nose, mouth,throat, and external genitalia were associated with adenocarcinoma ofthe breast in a 61-year-old woman.
===========================================================
37.) A case of hepatocellular carcinoma with the sign of Leser-Trelat: apossible role of a cutaneous marker for internal malignancy.
===========================================================
Jpn J Med 1991 Jan-Feb;30(1):53-6 Related Articles, Books, LinkOut
Tajima H, Mitsuoka S, Ohtsuka E, Nakamura Y, Nakayama T, Satoh Y, Shima M, Nakata K, Kusumoto Y, Koji T, et al
First Department of Internal Medicine, Nagasaki University School of
Medicine, Japan.
A rare case of hepatocellular carcinoma who developed the complication of the sign of Leser-Trelat is reported. The patient, a 57-year-oldmale, visited our hospital with complaints of generalized malaise andanorexia. A diagnosis of hepatocellular carcinoma was made based onelevated alpha-fetoprotein measurement, ultrasonography, and hepaticarteriography findings. Chest x-ray film suggested pulmonary metastasesof hepatocellular carcinoma. Thereafter, complications of the seborrheickeratosis developed in the trunk and the skin lesion was diagnosed asthe sign of Leser-Trelat associated with hepatocellular carcinoma. Thepatient died of pneumonia 9 months after development of the sign ofLeser-Trelat.
===========================================================
38.) the relation between seborrheic keratoses and malignant solidtumours. A case-control study.
===========================================================
Acta Derm Venereol 1991;71(2):166-9 Related Articles, Books
Grob JJ, Rava MC, Gouvernet J, Fuentes P, Piana L, Gamerre M, Sarles JC,
Bonerandi JJ
Service de Dermatologie, Hopital Ste Marguerite, Marseille, France.
In order to establish whether or not here is an association between cancer and intense growth of seborrheic keratosis, the so-calledLeser-Trelat sign, we conducted a case control study in which the numberand features of seborrheic keratosis in 82 patients with recent solid tumours, were compared with 82 age- and sex-matched controls. Neithernumbers nor features of seborrheic keratosis differed significantly inpatients and controls. Eruptive seborrheic keratosis was noted in onlyone patient and one control.
This study showed that solid malignanciesare not generally associated with an increase in the number or size ofseborrheic keratosis lesions, thus suggesting that they are not controlled by a hypothetical secretion of growth factors by tumours. Ourresults suggest that Leser-Trelat is either a coincidence, or at most avery rare sign of unusual types of cancer. We also showed that multiple cherry angiomas, previously reported to be a paraneoplastic sign, arenot regularly associated with solid tumours.
===========================================================
39.) [Useful cutaneous markers of internal malignancy in the earlystage].
===========================================================
Gan To Kagaku Ryoho 1988 Apr;15(4 Pt 2-3):1564-8 Related Articles, Books
Mori S
Dept. of Dermatology, Gifu University School of Medicine.
Numerous skin changes are correlated with internal malignancy. These skin changes are collectively called dermadromes of internal malignancyor syndroma dermato-tumorale. The skin markers of internal malignancycan be classified into
1) skin metastasis,
2) paraneoplastic dermatoses,
3) cutaneous manifestations of the systemic carcinogenic disease processand
4) cancer-malformation syndrome.
For diagnosis of the early stage ofinternal malignancy, paraneoplastic dermatoses are the most importantamong other skin changes. Above all, dermatomyositis, figurate erythemas, erythroderma and a number of bullous dermatoses (e.g.,bullous pemphigoid, pemphigus vulgaris and dermatitis herpetiformis,Sweet' syndrome, pruritus, prurigo, acanthosis nigricans, Leser-Trelatsign, alopecia mucinosa, acquired ichthyosis, Bazex' syndrome,hypertrichosis aquisita lanuginosa) are among the paraneoplasticdermatoses.
A total of 405 cases of syndroma dermato-tumorale except cases of skin metastasis were reported for recent 7 years (1980-1986)only in the dermatological field in Japan. Among them, cases ofparaneoplastic dermatoses number 354 accounting for the majority. Finally, brief consideration is given to the relationship between theabove mentioned skin manifestations and internal malignancy.
===========================================================
40.) [Gastrointestinal carcinoma with skin diseases from the standpointof surgery].
===========================================================
Gan To Kagaku Ryoho 1988 Apr;15(4 Pt 2-3):1560-3 Related Articles, Books
Nishidoi H, Koga S, Kanbe N
1st Dept. of Surgery, Tottori University School of Medicine.
We encountered 21 patients with gastrointestinal carcinoma accompanied with skin diseases such as acanthosis nigricans, dermatomyositis,pemphigoid, erythrodermia, ichthyosis vulgaris, herpes zoster,Leser-Trelat's sign, Recklinghausen's disease and Gardner's syndrome. Wehave discussed such cases from the standpoint of surgery. There were 16cases (76%) with gastric carcinoma, which were almost in the faradvanced stage. Carcinomas of the other patients were seen in the esophagus, liver, pancreas, small intestine and rectum. Although skinlesions appeared before the onset of gastrointestinal symptoms in almostall cases, detection of carcinomas was very difficult until the symptomsemerged. In 6 of 21 patients (29%), carcinomas were detected by onlyskin manifestation, and they proved to be gastric cancer in all cases. Although the relationship of gastrointestinal carcinoma and skindiseases was unclear, we presented a 70-year-old woman with acanthosisnigricans accompanied with gastric cancer, whose skin manifestation wasreduced by the therapy for gastric cancer. Therefore, some of these skinmanifestation may be a symptom of the biological characteristics of thegastrointestinal carcinoma.
===========================================================
41.) [Leser-Trelat sign in adenocarcinoma of the sigmoid colon--a rareclinical picture].
===========================================================
Z Hautkr 1987 Jun 1;62(11):875-6 Related Articles, Books
Hodak E, Halevy S, Ingber A, Engelstein D, Sandbank M
We report on a 75-year-old man showing the very rare association of Leser-Trelat's sign and adenocarcinoma of the sigmoid colon. Our case isthe second one reported so far.
===========================================================
42.) [Acanthosis nigricans maligna and Leser-Trelat sign in doublemalignancy of the breast and stomach].
===========================================================
Z Hautkr 1987 Mar 1;62(5):344-66 Related Articles, Books
Stieler W, Plewig G
A female patient with primary cancer of the breast and the stomach developed acanthosis nigricans maligna and Leser-Trelat's sign.Acanthosis nigricans maligna is a well-known cutaneous marker ofinternal malignancy. It may be intensified by radiotherapy. A variant is called florid cutaneous papillomatosis. Leser-Trelat's sign is a rarecutaneous marker of internal neoplasms. According to the literature, wepresent 46 patients showing Leser-Trelat's sign. Neither Leser norTrelat described this sign. ===================================================================
43.) Beitrage Zur Fruhdiagnose des darmcarcinoms (Hereditasverhaltnisse und Hautveranderungen) hollander E
Dtsch Med Woschenschr 1900;26:483-5
===================================================================
===================================================================
44.) Seborrheic Keratoses as the First Sign of Bladder Carcinoma: Case
Report of Leser-Trélat Sign in a Rare Association with Urinary Tract
Cancer.
==============================================================
Case Rep Med. 2016;2016:4259190. doi: 10.1155/2016/4259190. Epub 2016
Nov 23.
Stollmeier A1, Rosario BA2, Mayer BL2, Frandoloso GA2, Magalhães FL2,
Marques GL2.
Author information
1Federal University of Paraná, Curitiba, PR, Brazil.
2Internal Medicine Department, Clinics Hospital of the Federal
University of Paraná, Curitiba, PR, Brazil.
Abstract
Introduction. Skin disorders can be the first manifestation of occult
diseases. The recognition of typical paraneoplastic dermatoses may
anticipate the cancer diagnosis and improve its prognosis. Although
rarely observed, the sudden appearance and/or rapid increase in number
and size of seborrheic keratoses can be associated with malignant
neoplasms, known as the sign of Leser-Trélat. The aim of this report is
to unveil a case of a patient whose recently erupted seborrheic
keratoses led to investigation and consequent diagnosis of bladder
cancer. Case Presentation. A 67-year-old man was admitted to the
intensive care unit due to an exacerbation of chronic obstructive
pulmonary disease (COPD). On physical examination, multiple seborrheic
keratoses on the back of the hands, elbows, and trunk were observed; the
patient had a 4-month history of these lesions yet was asymptomatic. The
possibility of Leser-Trélat syndrome justified the investigation for
neoplasia, and a bladder carcinoma was detected by CT-scan. The patient
denied previous hematuria or any other related symptoms. Many of the
lesions regressed during oncologic treatment. Conclusion. Despite the
critics on the validity of the sign of Leser-Trélat, our patient
fulfills the description of the disease, though urinary malignancy is a
rare association. That corroborates the need of further investigation
when there is a possibility of paraneoplastic manifestation.
==============================================================
45.) Leser-Trélat Sign in Tumor-Stage Mycosis Fungoides.
==============================================================
Dermatol Online J. 2016 Apr 18;22(4). pii: 13030/qt76c2m5jr
Rowe B1, Shevchenko A, Yosipovitch G.
Author information
1Department of Dermatology and Itch Center, Temple University School of
Medicine.
Abstract
A 71-year-old man presented with numerous pruritic seborrheic keratoses,
with an eruptive onset over the course of 3 months. At presentation, he
was also found to have hypopigmented tumors diffusely scattered
throughout his body that were found to be mycosis fungoides on
histologic examination. A theory regarding the pathophysiology of the
development of eruptive seborrheic keratoses in the presence of mycosis
fungoides is briefly discussed and 10 previous case reports of the
Leser-Trélat sign in the setting of mycosis fungoides are
reviewed.
==============================================================
46.) Cutaneous manifestations of lung cancer.
==============================================================
Semin Oncol. 2016 Jun;43(3):366-9. doi:
10.1053/j.seminoncol.2016.02.025. Epub 2016 Feb 23.
Owen CE1.
Author information
1University of Louisville, Division of Dermatology, Louisville, KY.
Electronic address: ceowen01@louisville.edu.
Abstract
Skin findings can serve as a clue to internal disease. In this article,
cutaneous manifestations of underlying lung malignancy are reviewed.
Paraneoplastic dermatoses are rare, but when recognized early, can lead
to early diagnosis of an underlying neoplasm. Malignancy-associated
dermatoses comprise a broad group of hyperproliferative and inflammatory
disorders, disorders caused by tumor production of hormonal or metabolic
factors, autoimmune connective tissue diseases, among others. In this
review, paraneoplastic syndromes associated with lung malignancy are
discussed, including ectopic ACTH syndrome, bronchial carcinoid variant
syndrome, secondary hypertrophic osteoarthropathy/digital clubbing,
erythema gyratum repens, malignant acanthosis nigricans, sign of
Leser-Trélat, tripe palms, hypertrichosis lanuginosa, acrokeratosis
paraneoplastica, and dermatomyositis.
==============================================================
47.) Leser-Trelat sign with primary hepatic carcinoma.
=============================================================
Indian J Dermatol Venereol Leprol. 2015 May-Jun;81(3):320-1. doi:
10.4103/0378-6323.154792.
Li JH1, Guo H, Li B, Gao XH.
Author information
1Department of Dermatology, No. 1 Hospital of China Medical University,
Shenyang, China.
===============================================================
48.) Clinical image in gastroenterology. The sign of Leser-Trélat
associated with rectal carcinoma.
===============================================================
Rev Gastroenterol Mex. 2014 Oct-Dec;79(4):294-5. doi:
10.1016/j.rgmx.2014.05.002. Epub 2014 Jun 16.
[Article in English, Spanish]
Martínez-Hernández Magro P1, Jaime Báez-García JJ2, Báez-Aviña J2.
Author information
1Departamento de Cirugía de Colon y Recto y Departamento de
Dermatología, Hospital Guadalupano de Celaya, Celaya Guanajuato, México.
Electronic address: paulinomhm@hotmail.com.
2Departamento de Cirugía de Colon y Recto y Departamento de
Dermatología, Hospital Guadalupano de Celaya, Celaya Guanajuato, México.
=================================================================
49.) [Leser-Trélat sign associated with gastric cancer: report of one
case].
=================================================================
[Article in Spanish]
Venegas FA1, Vaccaro PM, Abudinén GA, Reydet CV, Brunie FV, Arcuch JD.
Author information
1Servicio Urgencias, Hospital Víctor Río Ruiz, Los Ángeles, Chile.
Abstract
We report a 66-year-old male presenting with malaise, heartburn and
pruritic seborrheic keratoses in both feet of sudden onset, suggesting a
Leser-Trélat sign. An upper gastrointestinal endoscopy disclosed a
gastric cancer. The patient was subjected to a total gastrectomy and
during follow up, the skin lesions had disappeared.
==================================================================
50.) Sign of Leser-Trélat in association with laryngeal carcinoma.
==================================================================
Nyati A1, Kalwaniya S, Jain S, Soni B.
Author information
1Department of Dermatology, Venereology and Leprology, Government
Medical College, Kota, Rajasthan, India.
==================================================================
51.) [Leser-Trelat sign associated with pancreatic cancer].
==================================================================
Med Clin (Barc). 2016 May 20;146(10):470. doi:
10.1016/j.medcli.2015.10.029. Epub 2016 Jan 28.
[Article in Spanish]
Cuervo Pinna MÁ1.
Author information
1Equipo de Cuidados Paliativos de Badajoz, Programa Regional de Cuidados
Paliativos de Extremadura, Badajoz, España. Electronic address:
miguelangel.cuervop@gmail.com.
===================================================================
52.) Sign of leser-trélat associated with esophageal squamous cell
cancer.
===================================================================
Case Rep Oncol Med. 2014;2014:825929. doi: 10.1155/2014/825929. Epub
2014 Feb 6.
Gaduputi V1, Chandrala C1, Tariq H1, Kanneganti K1.
Author information
1Department of Medicine, Bronx Lebanon Hospital Center, 1650 Selwyn
Avenue, Suite No. 10C, Bronx, NY 10457, USA.
Abstract
The sign of Leser-Trélat is a rare paraneoplastic phenomenon marked by
accelerated onset of multiple seborrheic keratoses. The occurrence of
the sign often points towards underlying visceral malignancies which in
a majority are adenocarcinomas of the gastrointestinal tract. We report
this case of a 65-year-old man who presented with sign of Leser-Trélat
and was diagnosed with poorly differentiated squamous cell cancer of the
esophagus. To our knowledge this is only the second such reported
association of Leser-Trélat sign with squamous cell cancer of
esophagus.
===================================================================
53.) Leser-Trélat sign: does it really exist?
===================================================================
Turan E1, Yesilova Y, Yurt N, Koçarslan S.
Author information
1Department of Dermatology, Faculty of Medicine, University of Harran,
63200-Sanliurfa, Turkey. enverturan@gmail.com
Abstract
Leser-Trélat sign is a rare cutaneous disorder that manifests with
sudden emergence of seborrheic keratoses and increase in their numbers
and size within weeks or months. Its concurrence with many types of
malignancies, especially adenocarcinoma and lymphoma, has been reported
in the literature. In this case report, a patient having Leser-Trélat
sign, without any detected malignancy in spite of detailed examination
and 18 months of follow up, is presented. Current literature is reviewed
in relation to the debate whether Leser-Trélat is a paraneoplastic
syndrome or not.
===================================================================
54.) Sign and pseudo-sign of Leser-Trélat: case reports and a review of
the literature.
===================================================================
J Drugs Dermatol. 2013 May;12(5):e79-87
Husain Z1, Ho JK, Hantash BM.
Author information
1Georgetown University Hospital, Washington Hospital Center, Washington
DC, USA.
Abstract
BACKGROUND:
Leser-Trélat is distinguished by a rare paraneoplastic sign that is
characterized by the sudden eruption of multiple seborrheic keratoses
(SKs), associated with underlying internal malignancies. Similar
non-malignancy-associated SK eruptions are referred to as the
"pseudo-sign of Leser-Trélat" (PLT).
OBJECTIVE:
Two cases of rapid SK eruptions, one the sign of Leser-Trélat (SLT) and
one PLT, are presented, and the literature on SLT and PLT is reviewed.
METHODS:
A literature review of SLT/PLT was performed by searching the PubMed
database for all related English published cases.
RESULTS:
We identified 109 cases of SLT and 12 cases of PLT, with a mean patient
age of 61.8 years. SK eruptions were observed before (68.3%), after
(22.1%), and at the time of (9.6%) malignancy diagnosis. The malignancy
most frequently associated with SLT was gastric adenocarcinoma. The most
common anatomical location of SK eruptions was the trunk (18.9%).
Frequently reported associated signs and symptoms included pruritus
(52%) and acanthosis nigricans (38.7%). The most common treatment
included surgery (35.8%), chemotherapy (26.9%), and radiation therapy
(26.9%). Treatment resulted in clinical improvement (45%), no change
(30%), exacerbation (15%), or initial improvement followed by
exacerbation of SKs. Patient outcomes included disease stability/
improvement (48.4%), recurrence (9.7%), exacerbation/metastasis/new
malignancy (4.8%), and death (37.1%).
LIMITATIONS:
This was a retrospective study and excluded non-English published cases.
CONCLUSION:
This review updates the existing SLT literature and emphasizes the
presence of PLT. Clinicians should be aware that SK eruptions may be
early manifestations of an internal malignancy or other pathology. To
our knowledge, this is the first review examining both SLT and PLT.
===================================================================
55.) Chemotherapy-induced inflammatory seborrheic keratoses in a man
with acute myeloid leukemia: a variant of Leser-Trélat sign?
====================================================================
Cutis. 2012 Nov;90(5):235-6.
Lilly E1, Granter SR, Haynes HA, Ibrahimi OA.
Author information
1Department of Dermatology, Harvard Medical School, Brigham and Women's
Hospital, Boston, Massachusetts, USA.
Abstract
Leser-Trélat sign is a controversial paraneoplastic phenomenon
characterized by an eruption of seborrheic keratoses (SKs). We report a
rare case of eruptive inflammatory SKs in a man undergoing induction
chemotherapy for acute myeloid leukemia (AML). We also review the
literature on Leser-Trélat sign.
===================================================================
56.) [Clinical and histopathological characteristics of early
Leser-Trélat syndrome].
===================================================================
Hautarzt. 2001 Jul;52(7):649-52
[Article in German]
Barth G1, Basten O, Rüschoff J, Rompel R.
Author information
1Hautklinik, Klinikum Kassel, Akademisches Lehrkrankenhaus,
Philipps-Universität Marburg.
Abstract
Leser-Trélat-syndrome is characterized as the eruptive appearance of
multiple seborrheic keratoses in association with underlying malignant
disease. A 73 year old female patient with a metastatic adenocarcinoma
of the colon presented with this paraneoplastic change. The rapid
appearance of solitary seborrheic keratoses with associated
inflammation, seen clinically and histologically, may be an early sign
of Leser-Trélat-syndrome. The recognition of this inflammatory component
as an early sign may contribute to the prompt diagnosis of this
paraneoplasia, even before the eruption of numerous seborrheic
keratoses.
=======================================================================
57.) A Case of Leser-Trélat Syndrome Associated with a Renal Cell
Carcinoma.
======================================================================
Barth D1, Puhlmann S2, Barth J1.
Author information
1Praxis für Haut- und Geschlechtskrankheiten Dr. Barth Leipzig/Borna,
Germany.
2Klinik für Urologie - Sana Klinikum Borna, Borna, Germany.
Abstract
Seborrheic keratoses can often be found in elderly people. In general,
they appear gradually. In cases of a sudden eruption with itching it
might be paraneoplastic. Although some authors doubt the existence of
the paraneoplastic Leser-Trélat syndrome, we present a case of sudden
eruption of seborrheic keratoses connected with a newly diagnosed renal
cell carcinoma. As far as we know, this is the first case report of a
Leser-Trélat syndrome with a malignancy of the kidney.
========================================================================
58.) Leser-Trélat Sign without Internal Malignancy.
=======================================================================
Safa G1, Darrieux L.
Author information
1Department of Dermatology, Centre Hospitalier de Saint-Brieuc,
Saint-Brieuc, France.
Abstract
Leser-Trélat sign is characterized by the abrupt appearance of multiple
seborrheic keratoses in association with underlying malignant disease. A
case of Leser-Trélat sign in a 66-year-old healthy woman is presented.
Evaluation and follow-up for the development of malignancy over a 2-year
period failed to reveal any evidence of malignancy. To date, almost all
cases of Leser-Trélat sign have been reported in association with an
underlying malignancy. It is less known that Leser-Trélat sign can also
occur in healthy individuals in the absence of internal malignancy.
========================================================================
59.) Leser-Trelat sign in metastasized malignant melanoma.
========================================================================
Eur Arch Otorhinolaryngol. 2009 Feb;266(2):297-9. doi:
10.1007/s00405-008-0636-6. Epub 2008 Mar 28.
Siedek V1, Schuh T, Wollenberg A.
Author information
1Department of Otorhinolaryngology, Ludwig-Maximilian University,
Marchioninistr. 15, 81377 Munich, Germany.
vanessa.siedek@med.uni-muenchen.de
Abstract
The Leser-Trelat sign is defined as the association of multiple,
eruptive seborrheic keratoses with an internal malignancy of a usually
advanced stage. We report the case of malignant melanoma in an
82-year-old man covered with hundreds of greyish-dark seborrheic
keratoses resembling a Christmas tree pattern, who was diagnosed with
metastasized malignant melanoma involving the parotid gland and lymph
nodes. Though the pathogenesis of Leser-Trelat sign is still unknown,
spontaneous regression of the seborrheic keratoses following tumor
reduction described in some cases argues for a paraneoplastic origin of
this highly instructive clinical entity. Physicians should consider a
workup for internal malignancy in patients presenting with multiple
eruptive seborrheic keratoses.
========================================================================
60.) Trélat sign presenting in a patient with ovarian cancer: a case
report.
=======================================================================
J Med Case Rep. 2009 Jul 23;3:8583. doi: 10.4076/1752-1947-3-8583
Bölke E, Gerber PA, Peiper M, Knoefel WT, Cohnen M, Matuschek C, Budach
W, Engers R, Gripp S.
Abstract
INTRODUCTION:
Seborrheic keratoses are very common findings in elderly patients.
However, a sudden onset and dramatic increase in the number and size of
these benign lesions deserves special attention, since this may
represent the Leser Trélat sign, a rare paraneoplastic cutaneous
syndrome.
CASE PRESENTATION:
A 92-year-old female presented to our clinic with multiple eruptive
seborrheic keratoses, which had dramatically increased in size and
number over the past two years. A diagnostic work-up revealed an ovarian
carcinoma. Hence, cutaneous findings in our patient were consistent with
the diagnosis of the Leser-Trélat sign.
CONCLUSION:
The Leser-Trélat sign may coincide with the diagnosis of occult cancer
or follow or precede it by months or years. Practitioners should take
cases of eruptive seborrheic keratoses seriously and perform thorough
patient examinations.
========================================================================
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