SHM Converge Scientific Abstract ePoster Gallery-Leser-Trelat Sign With High Grade Neuroendocrine Cancer

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A 71-year-old woman presented with right flank pain and postmenopausal bleeding. Imaging showed bilateral pleural effusions, diffuse lymphadenopathy, and right ureteropelvic junction obstruction with hydronephrosis, which improved after stenting. During her hospital course, she developed a pruritic morbilliform rash after cefdinir exposure, and exam revealed multiple new seborrheic keratoses diffusely across her back.<br /><br />Further workup demonstrated poorly differentiated carcinoma with neuroendocrine features on lymph node aspiration. Subsequent staging scans showed bulky, intensely FDG-avid supradiaphragmatic and infradiaphragmatic lymphadenopathy and gastric involvement. Her course was complicated by gastrointestinal bleeding, and endoscopy identified a 6-cm infiltrative transverse colon mass. Given the advanced malignancy and complications, she ultimately transitioned to comfort-focused care.<br /><br />This case highlights the Leser-Trélat sign, first described in the 1800s, in which the abrupt onset of numerous seborrheic keratoses may signal an underlying cancer. It is most often associated with adenocarcinomas, especially gastrointestinal tumors, but can also occur with other malignancies. The presumed mechanism involves tumor-related growth factors such as insulin-like growth factor and epidermal growth factor, which stimulate keratinocyte proliferation. When the underlying cancer is treated, the skin lesions may partially or completely regress.<br /><br />The key teaching point is that sudden development of widespread seborrheic keratoses, particularly when accompanied by itching or a symmetric distribution on the back, should prompt suspicion for an occult malignancy and appropriate age-based cancer screening.

Asset Subtitle

Michael A. Durda

Meta Tag

Author List Julie C. Kielt, Michael A. Durda

Category Clinical Vignettes

Concept Leser-Trélat Sign

Concept Seborrheic Keratosis

Concept Malignancy

Concept Paraneoplastic Syndrome

Concept Adenocarcinoma

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center

Presenting Author Michael A. Durda

Track Adult

Keywords

Leser-Trélat sign

seborrheic keratoses

occult malignancy

gastrointestinal cancer

poorly differentiated carcinoma

neuroendocrine features

diffuse lymphadenopathy

transverse colon mass

postmenopausal bleeding

hydronephrosis

Leser-Trélat Sign

Seborrheic Keratosis

Malignancy

Paraneoplastic Syndrome

Adenocarcinoma