The diagnosis of cancer may not always be as straightforward as pinpointing a mass in the body. A malignancy may show signs which if followed lead to a diagnosis.
The signs can be anything, depending upon the type of malignancy and the organ involved, the signs and symptoms indicating the presence of malignancy are quite variable.
Here is a case presentation:
A 73-year-old woman with 30 pack-years smoking history presented to the dermatology clinic with a 9-month history of painful, itchy lesions on the palms of her hands. The past medical history was insignificant except for a cough that had been present for 1 year and a 5-kg weight loss in the past 4 months.
On examination of her hands, sharply delineated folds were observed in the lines of her hands and the palm had a velvet-like appearance (Panel A).
Such palms are called tripe palms, acanthosis palmaris, and acquired pachydermatoglyphia. The name ‘tripe’ is attributable to the velvety appearance, similar to the stomach lining of a cow, pork, or sheep.
The examination of such palms, although a rare finding, indicates malignancy in 90 % of the cases, usually preceding the diagnosis of cancer. The most common malignancies associated with tripe palms are lung and gastric carcinoma.
Therefore, after observing tripe palms in the patient, computed tomography of the chest (Panel B), abdomen, and pelvis were performed to rule out malignancy.
The results revealed an irregular pulmonary nodule in the left upper lobe of the lung. The mediastinal lymph nodes were also enlarged.
Specimens were collected from the pulmonary nodule and the mediastinal lymph nodes for histopathological evaluation, which confirmed the diagnosis of adenocarcinoma. Treatment was initiated. The patient was started on chemo- and radiotherapy along with the application of 10% urea-containing ointment. None of the treatment worked and the tripe palms persisted. After six months of presentation, the malignancy had progressed, so a second-line chemotherapy regimen was initiated.
References
Denis Miyashiro, M.D., and Jose A. Sanches, M.D., Ph.D. (2019, November 14). Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1902529
Ngan, V. (2005). Tripe palms. Retrieved from DermNet NZ: https://dermnetnz.org/topics/tripe-palms/
