Malignant acanthosis nigricans with Leser–Trélat sign and tripe palms: A case report

Figure 1 Patient’s skin appearance and examination results. A: Skin lesions; B: Cervical pathology: Epidermal hyperkeratosis, basal cell hyperplasia, pigmentation, and papilla protrusion (hematoxylin–eosin staining: 100 ×); C-E: Facial flat brown maculopapular pathology: Basal cell papilloma, hyperpigmentation, and hyperkeratosis (C: Hematoxylin–eosin staining: 40 ×; D: Hematoxylin–eosin staining: 100 ×; E: Hematoxylin–eosin staining: 200 ×); F and G: A dermoscopic examination of the surface of the hand showed consistent gray–brown papillary hyperplasia and diffuse dark brown to black–gray pigmentation with slight scales.

Figure 2 Patient’s examination results and skin changes before and after treatment. A and B: Gastroscopy at Xijing Hospital: Gastroscopy of the upper part of the stomach under the patient’s cardia showed a large mucous membrane bulge near the posterior wall, with an uneven surface and large areas of ulceration. The biopsy was brittle, and a diagnosis of cardiac gastric cancer was made; C and D: A gastroscopic biopsy at Xijing Hospital showed that the heteromorphic cells had been arranged in glandular, ribbon-like, and lamellar patterns, with obvious atypia and invasive growth. Diagnosis: Cancer of the gastric cardia with medium-poorly differentiated adenocarcinoma (C: Areas of poorly differentiated adenocarcinoma, hematoxylin–eosin staining: 200 ×; D: Areas of medium differentiated adenocarcinoma, hematoxylin–eosin staining: 200 ×); E: Computed tomography scan before neoadjuvant chemotherapy showed thickening of the gastric cardia wall (orange arrow) and enlargement of the peripheral lymph nodes (white arrow); F: After three cycles of neoadjuvant chemotherapy, computed tomography scan showed that the tumor (orange arrow) and surrounding lymph nodes (white arrow) were significantly reduced; G: Tumor invasion of the pancreas was observed during surgery; H: After three cycles of chemotherapy, skin pigmentation was reduced.