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Year : 2014  |  Volume : 59  |  Issue : 3  |  Page : 318
A 68 year old male with abdominal pain, anorexia, and facial skin pigmentation

Department of Internal Medicine, Urmia University of Medical Sciences, Emam Khomeini Hospital, Urmia, Iran

Date of Web Publication28-Apr-2014

Correspondence Address:
Nasim Valizadeh
Department of Internal Medicine, Section of Hematology/Medical Oncology, Urmia University of Medical Sciences, Emam Khomeini Hospital, Urmia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.131482

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How to cite this article:
Valizadeh N. A 68 year old male with abdominal pain, anorexia, and facial skin pigmentation. Indian J Dermatol 2014;59:318

How to cite this URL:
Valizadeh N. A 68 year old male with abdominal pain, anorexia, and facial skin pigmentation. Indian J Dermatol [serial online] 2014 [cited 2020 Sep 24];59:318. Available from: http://www.e-ijd.org/text.asp?2014/59/3/318/131482

A 68-year-old, heavy smoker male was admitted with abdominal pain and distention. He had weight loss and constipation since 1 year ago and loss of appetite since 2 months ago. He complained from facial skin darkening since 1 year ago.

Physical examination showed skin thickening, pigmentation in his face, and upper parts of neck [Figure 1] and hepatomegaly.
Figure 1: Skin pigmentation in his face and upper parts of neck

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Laboratory findings are included: WBC = 13000/μl, Hb = 15 gr/dl, Plt count = 254000/μl. AST = 48 (normal < 50 U/L), ALT = 20 (normal < 50 U/L), alkaline phosphatase = 1048, high (normal: 80-306 U/L), CEA = 38 (normal < 8 for smokers).

FBS, Na, K, BUN, and Cr all were reported normally. HBs Ag and HCV Ab were negative. Sonograpghy showed hepatomegaly with multiple mass lesions in liver lobes suggestive of liver metastasis. Upper GI endoscopy showed severe erosive gastritis. Liver biopsy showed carcinoma (primary or secondary). Immunohistochemistrical (IHC) study on biopsy was reported positive for keratin, EMA, SMA, and negative for S100, PSA, MA, CD117) that recommended epithelial, myoepithelial origin for cancer.

   Question Top

What is your diagnosis for [Figure 1]?

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   References Top

1.Mukherjee S, Pandit S, Deb J, Dattachaudhuri A, Bhuniya S, Bhanja P. A case of squamous cell carcinoma of lung presenting with paraneoplastic type of acanthosis nigricans. Lung India 2011;28:62-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Stoddart ML, Blevins KS, Lee ET, Wang W, Blackett PR. Cherokee Diabetes Study. Association of acanthosis nigricans with hyperinsulinemia compared with other selected risk factors for type 2 diabetes in Cherokee Indians: The Cherokee Diabetes Study. Diabetes Care 2002;25:1009-14.  Back to cited text no. 2
3.Krawczyk M, Mykala-Ciesla J, Kolodziej-Jaskula A. Acanthosis nigricans as a paraneoplastic syndrome. Case reports and review of literature. Pol Arch Med Wewn 2009;119:180-3.  Back to cited text no. 3
4.Brown J, Winkelmann RK. Acanthosis nigricans: A study of 90 cases. Medicine (Baltimore) 1968;47:33-51.  Back to cited text no. 4
5.Berk DR, Spector EB, Bayliss SJ. Familial acanthosis nigricans due to K650T FGFR3 mutation. Arch Dermatol 2007;143:1153-6.  Back to cited text no. 5


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