A Leser-Trelat Case Related With Mycosis Fungoides

Abstract

The sign of Leser-Trelat, a rare finding, is the sudden eruption of multiple seborrhoeic keratoses caused by a malignancy. It was reported to be accompanied by many various internal malignancies. It is rarely accompanied with mycosis fungoides (MF) and Sezary syndrome. A 67-year old male patient applied to our polyclinics with the complaint of red and black spots on his body. Hystopathological examination of the biopsy material taken from the erythematic lesions on the body was found as MF and the hyperpigment papules and plaques clinically were diagnosed as seborrhoeic keratoses. PUVA treatment was initiated on the patient, who was diagnosed as mycosis fungoides and leser-trelat accompaniment based on the clinical and hystopathological findings. The lesions with MF and seborrhoeic keratoses have regressed in the patient, who is still being followed and treated. ©2008, Firat University, Medical Faculty

Keywords

• -

Mikozis Fungoides ile Leser-Trelat Birlikteliği Olan Bir Olgu

Öz

Leser-Trelat belirtisi malignensilerin neden olduğu aniden artış gösteren çok sayıda seboreik keratoz lezyonlarıyla karakterize nadir görülen bir bulgudur. Çok sayıda değişik internal malignensilerle birlikteliği rapor edilmiştir. Mikozis fungoides (MF) ve Sezary Sendromuyla birlikteliği ise son derece nadirdir. 67 yaşında erkek hasta vücutta kırmızı ve siyah renkli lekelenme şikayeti ile polikliniğimize başvurdu. Gövdedeki eritemli lezyonlardan alınan biopsi materyalinin histopatalojik incelenmesi MF ile uyumlu bulunurken hiperpigmente papül ve plaklara klinik olarak seboreik keratoz tanısı konuldu. Klinik ve histopatolojik bulgularla MF ve leser-trelat birlikteliği tanısı konulan hastaya PUVA tedavisi başlandı. Takip ve tedavisi devam eden hastanın MF ve seboreik keratozla ile uyumlu lezyonları geriledi.©2008, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• Mikozis fungoides, Leser-Trelat belirtisi

References

1. Weismann K, Graham RM. Systemic Disease and the Skin. In: Champion RH, Burton JL. Burns DA Breathnach SM (editors). Textbook of Dermatology. 6th ed, Oxford: Blachwell science ltd, 1998: 2703-2757.
2. Odom RB, James WD, Berger TG. Andrews’ Diseases of the skin 9th ed, Philadelphia: WB Saunders, 2000: 918-942.
3. Toonstra J, Ramselaar CG, van der Putte SC. Leser-Trelat sign in mycosis fungoides. A further case report. Dermatologica 1985; 171: 247-249
4. Greer KE, Hawkins H, Hess C. Leser-Trelat associated with acute leukemia. Arch Dermatol 1978; 114: 1552.
5. Safai B, Grant JM, Good RA. Cutaneous manifestation of internal malignancies (II): the sign of Leser-Trelat. Int J Dermatol 1978; 17: 494-495.
6. Lambert D, Fort M, Legoux A, Chapuis JL. The Leser-Trelat symptom: report of two cases. Ann Dermatol Venereol 1980; 107: 1035-1041.
7. Dantzig PI. Sign of Leser-Trelat. Arch Dermatol 1973; 108: 700701.
8. Halevy S, Halevy J, Feuerman EJ. The sign of Leser-Trelat in association with lymphocytic lymphoma. Dermatologica 1980; 161: 183-186.

9. Wagner RF, Wagner KD. Malignant neoplasms and the LeserTrelat sign. Arch Dermatol 1981; 117: 598-599.
10. Schwartz RA. Sign of Leser-Trelat. J Am Acad Dermatol 1996; 35: 88-95.
11. Schwartz RA. Acanthosis nigricans. J Am Acad Dermatol 1994; 31: 1-19.
12. Wincent CY. Benign Epithelial Tumors. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB (editors). Fitzpatrick’s Dermatology in General Medicine. 5th ed, New York: Mc Graw Hill, 1999: 873-890.
13. Heng MC, Soo-Hoo K, Levine S, Petresek D. Linear seborrheic keratoses associated with underlying malignancy. J Am Acad Dermatol 1988;18: 1316-1321.
14. Ellis DL, Kafka SP, Chow JC, Nanney LB, Inman WH, McCadden ME, King LE Jr. Melanoma, growth factors, acanthosis nigricans, the sign of Leser-Trelat, and multiple acrochordons. A possible role for alpha-transforming growth factor in cutaneous paraneoplastic syndromes. N Engl J Med 1987; 317: 1582-1587.
15. Ellis DL, Yates RA. Sign of Leser-Trelat. Clin Dermatol 1993; 11: 141-148.
16. Tajima H, Mitsuoka S, Ohtsuka E, Nakamura Y, Nakayama T, Satoh Y, Shima M, Nakata K, Kusumoto Y, Koji T, et al. A case of hepatocellular carcinoma with the sign of Leser-Trelat: a possible role of a cutaneous marker for internal malignancy. Jpn J Med 1991; 30: 53-56.