Paraneoplastik Dermatolojik Sendromlar
Özet
Paraneoplastik dermatolojik sendromlar, malign neoplazmlara eşlik eden ancak malign hücre içermeyen, derinin tümöral infiltrasyonu olmaksızın gelişen heterojen cilt bozukluklarıdır. Bu dermatozların patofizyolojisinde, tümör tarafından üretilen büyüme faktörleri, sitokinler veya immün sistem uyarısı gibi mekanizmalar rol oynamaktadır. Klinik önemleri, çoğunlukla altta yatan okült bir kanserin ilk belirtisi olarak ortaya çıkabilmelerinden kaynaklanır; bu durum erken teşhis sürecini önemli ölçüde hızlandırır. Makalede dermatomiyozit, Sweet sendromu, eritroderma, nekrolitik migratuar eritem, paraneoplastik pemfigus, akantozis nigrikans, Leser-Trélat bulgusu, iktiyozis ve Bazex sendromu gibi en sık rastlanan paraneoplastik dermatozlar incelenmiştir. Bu sendromlar gastrointestinal sistem, akciğer, meme kanserleri ve hematolojik maligniteler gibi çok çeşitli kanser türleriyle ilişkilidir. Teşhis konulduğunda hastaların görüntüleme ve endoskopik yöntemlerle okült maligniteler açısından taranması gerekir. Dermatozların tedavisinde topikal veya sistemik steroidler gibi semptomatik ajanlar kullanılsa da, kesin ve kalıcı klinik iyileşme ancak altta yatan malign hastalığın definitif ve küratif tedavisiyle mümkün olmaktadır.
Paraneoplastic dermatological syndromes are heterogeneous skin disorders that accompany malignant neoplasms without containing malignant cells or direct tumoral infiltration of the skin. The pathophysiology of these dermatoses involves mechanisms such as growth factors and cytokines produced by the tumor, or the stimulation of immune responses. Their clinical significance lies in the fact that they often present as the initial manifestation of an underlying occult malignancy, thereby significantly accelerating the early diagnosis process. The article reviews the most common paraneoplastic dermatoses, including dermatomyositis, Sweet syndrome, erythroderma, necrolytic migratory erythema, paraneoplastic pemphigus, acanthosis nigricans, the sign of Leser-Trélat, acquired ichthyosis, and Bazex syndrome. These syndromes are associated with various cancers, such as gastrointestinal, lung, breast, and hematological malignancies. Upon diagnosis, patients must be screened for occult tumors using imaging and endoscopic evaluations. Although symptomatic agents like topical or systemic steroids are utilized to manage symptoms, definitive and permanent clinical resolution is typically achieved only through the successful treatment of the underlying primary malignancy.
Referanslar
Billet SE, Grando SA, Pittelkow MR. Paraneoplastic autoimmune multiorgan syndrome: review of the literature and support for a cytotoxic role in pathogenesis. Autoimmunity 2006; 39:617.
Nguyen VT, Ndoye A, Bassler KD, et al. Classification, clinical manifestations, and immunopathological mechanisms of the epithelial variant of paraneoplastic autoimmune multiorgan syndrome: a reappraisal of paraneoplastic pemphigus. Arch Dermatol 2001; 137:193.
Dario Didona, Luca Fania, Biagio Didona, et al. Paraneoplastic Dermatoses: A Brief General Review and an Extensive Analysis of Paraneoplastic Pemphigus and Paraneoplastic Dermatomyositis. Int J Mol Sci. 2020 Mar; 21(6): 2178. doi: 10.3390/ijms21062178.
Judy K. Qiang, Whan B. Kim, Akerke Baibergenova. Risk of Malignancy in Dermatomyositis and Polymyositis: A Systematic Review and Meta-Analysis. J cutan Med surg Mar/Apr 2017;21(2):131-136. doi: 10.1177/1203475416665601.
Dongying Chen , Shiwen Yuan, Xiangni Wu, et al. Incidence and predictive factors for malignancies with dermatomyositis: a cohort from southern China. Clin Exp Rheumatol Sep-Oct 2014;32(5):615-21.
D Di Rollo , D Abeni, M Tracanna, et al. Cancer risk in dermatomyositis: a systematic review of the literature. G Ital Dermatol Venereol. 2014 Oct;149(5):525-37.
Lu X, Yang H, Shu X, et al. Factors predicting malignancy in patients with polymyositis and dermatomyostis: a systematic review and meta-analysis. PLoS One 2014; 9:e94128.
Wen Chun Liu , Madeline Ho, Woon-Puay Koh, et al. An 11-year review of dermatomyositis in Asian patients. Ann Acad Med Singap 2010 Nov;39(11):843-7.
Cohen PR, Kurzrock R. Sweet's syndrome and cancer. Clin Dermatol. 1993;11:149–157.
Nelson CA, Stephen S, Ashchyan HJ, et al. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987.
Shinojima Y, Toma Y, Terui T. Sweet syndrome associated with intrahepatic cholangiocarcinoma producing granulocyte colony-stimulating factor. B. r J Dermatol. 2006;155:1103–1104.
P R Cohen , W R Holder, S B Tucker, et al. Sweet syndrome in patients with solid tumors. Cancer. 1993 Nov 1;72(9):2723-31. doi: 10.1002/1097-0142(19931101)72:9.
Raza S, Kirkland RS, Patel AA, et al. Insight into Sweet's syndrome and associated-malignancy: a review of the current literature. Int J Oncol. 2013;42:1516–152.
Nicolis GD, Helwig EB. Exfoliative dermatitis. A clinicopathologic study of 135 cases. Arch Dermatol 1973; 108:788.
V. N. Sehgal, G. Srivastava, K. Sardana. Erythroderma/exfoliative dermatitis: a synopsis. International Journal of Dermatology, vol. 43, no. 1, pp. 39–47, 2004.
King LE Jr, Dufresne RG Jr, Lovett GL, et al. Erythroderma: review of 82 cases. South Med J 1986; 79:1210.
C. Okoduwa and W. C. Lambert, “Erythroderma: review of a potentially life-threatening dermatosis,” Indian Journal of Dermatology, vol. 54, no. 1, pp. 1–6, 2009.
Afsharfard A, Atqiaee K, Lotfollahzadeh S, et al. Necrolytic migratory erythema as the first manifestation of glucagonoma. Case Rep Surg. 2012, 2012: 974210. doi: 10.1155/2012/974210.
Eldor R, Glaser B, Fraenkel M, et al. Glucagonoma and the glucagonoma syndrome - cumulative experience with an elusive endocrine tumour. Clin Endocrinol. 2011, 74: 593-598. 10.1111/j.1365-2265.2011.03967.x.
Lobo I, Carvalho A, Amaral C, et al. Glucagonoma syndrome and necrolytic migratory erythema. Int J Dermatol. 2010, 49: 24-29. 10.1111/j.1365-4632.2009.04220.x.
Chastain MA. The glucagonoma syndrome: a review of its features and discussion of new perspectives. Am J Med Sci 2001; 321:306.
Jong Hoon Kim and Soo-Chan Kim. Paraneoplastic Pemphigus: Paraneoplastic Autoimmune Disease of the Skin and Mucosa Front Immunol. 2019; 10: 1259.Published online 2019 Jun 4. doi: 10.3389/fimmu.2019.01259.
Nousari HC, Deterding R, Wojtczack H, et al. The mechanism of respiratory failure in paraneoplastic pemphigus. N Engl J Med 1999; 340:1406.
Uwe Wollina , Gesina Hansel , Torello Lotti , et al. Acanthosis Nigricans - A Two-Sided Coin: Consider Metabolic Syndrome and Malignancies. Open Access Maced J Med Sci 2019 May 13;7(18):3081-3084. doi: 10.3889/oamjms.2019.258. eCollection 2019 Sep 30.
Ning Wang , Peng-Jie Yu , Zhi-Lin Liu , et al. Malignant acanthosis nigricans with Leser-Trélat sign and tripe palms: A case report. World J Clin Cases 2020 Nov 26;8(22):5632-5638. doi: 10.12998/wjcc.v8.i22.5632.
Ellis DL, Kafka SP, Chow JC, et al. Melanoma, growth factors, acanthosis nigricans, the sign of Leser-Trélat, and multiple acrochordons. A possible role for alpha-transforming growth factor in cutaneous paraneoplastic syndromes. N Engl J Med 1987; 317:1582.
Courtney N. Bernett, George J. Schmieder.. Leser Trelat Sign. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan 2021 Sep 19.PMID: 29261959 Bookshelf ID: NBK470554.
Spelman LJ, Strutton GM, Robertson IM, et al. Acquired ichthyosis in bone marrow transplant recipients. J Am Acad Dermatol 1996; 35:17.
Aikaterini Patsatsi , Aikaterini Kyriakou , Vasilios Karavasilis , et al. Acquired ichthyosis triggered by an osseous hemangiopericytoma: a case report and review of the literature Case Rep Dermatol 2014 Jan 18;6(1):10-5. doi: 10.1159/000358294.
A Bazex, A Griffiths. Acrokeratosis paraneoplastica--a new cutaneous marker of malignancy. Br J Dermatol 1980 Sep;103(3):301-6. doi: 10.1111/j.1365-2133.1980.tb07248.x.
Bipasha Roy , Shari R Lipner. A Review of Nail Changes in Acrokeratosis Paraneoplastica (Bazex Syndrome). Skin Appendage Disord 2021 Apr;7(3):163-172. doi: 10.1159/000513828.
F Räßler , S Goetze , P Elsner. Acrokeratosis paraneoplastica (Bazex syndrome) - a systematic review on risk factors, diagnosis, prognosis and management. J Eur Acad Dermatol Venereol. 2017 Jul;31(7):1119-1136.doi: 10.1111/jdv.14199.
