LETTERS TO THE EDITOR

 

Alopecia areata as a paraneoplastic syndrome of gastric cancer

Alopecia areata como manifestación paraneoplásica de un adenocarcinoma gástrico

 

 

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Key words: Alopecia areata. Gastric cancer. Signet cell ring. Paraneoplastic.

Palabras clave: Alopecia areata. Carcinoma gástrico. Células en anillo de sello. Paraneoplásico.

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Dear Editor,

Alopecia areata (AA) is a non-scarring dermatologic condition usually distinguished by patches of hair loss on the scalp. It is characteristically associated with autoimmune diseases, stress or family history of AA. The relationship with tumors of the digestive tract has been reported in two cases: gastrointestinal stromal tumor (GIST) of esophageal origin (1) and gastric adenocarcinoma (2).

 

Case report

We report the case of a 38-year-old man who suddenly developed patchy regions of hair loss on the scalp. He began treatment with topical corticosteroids. Two months later he complained of lower back pain with mechanical characteristics. In addition, he also complained later of abdominal pain in the lower abdomen, vomiting and jaundice, with the following analytical findings: 328 U/L, GPT 995 U/L, GGT 406 U/L, FA 469 U/L, and total bilirubin 7.12 mg/dL (direct 5.8 mg/dL). In the lumbar MRI scan, multiple bone blastic lesions suggestive of metastatic disease were observed. The abdominal CT showed a thickening of the gastric fundus and multiple lymphadenopathy retroperitoneals, in cardiophrenic angles and in the mesentery root. Endoscopy showed a subcardial lesion suggestive of malignancy and biopsy confirmed an adenocarcinoma with signet ring cells. Percutaneous cholangiography showed diffuse involvement of the biliary tree secondary to solid lesions. The patient presented clinical worsening and he died a month after diagnosis.

 

 

Discussion

Paraneoplastic cutaneous manifestations associated with gastric carcinoma include acanthosis nigricans, diffuse seborrheic keratosis and acquired pachydermatoglyphia (3).

To our knowledge, this is the second reported case of AA with gastric cancer. There are other published studies that show the association of AA with hematologic malignancies such as Hodgkin's lymphoma (4) and thymoma (5).

We believe that AA may be associated with malignant disorders, and thus this needs to be taken into account in the treatment of these patients.

 

Judith Álvarez-Otero, Francisco Fernández-Fernández and Javier de-la-Fuente-Aguado
Department of Internal Medicine. Hospital Povisa. Vigo, Spain

 

References

1. Axel J, Weickert U, Dancygier H. Gastrointestinal tumor (GIST) of the esophagus in a 34-year-old man: Clubbed fingers and alopecia arealis as an early paraneoplastic phenomenon. Dtsch Med Wochenschr 2005;130:2380-3. DOI: 10.1055/s-2005-918579.         [ Links ]

2. Molina Infante J, Hernández Alonso M, Martín Noguerol E, et al. Alopecia areata como presentación inicial paraneoplásica de un adenocarcinoma gástrico. Gastroenterol Hepatol 2009;32:128-30. DOI: 10.1016/j.gastrohep.2008.09.007.         [ Links ]

3. Silva JA, Mesquita Kde C, Igreja AC, et al. Paraneoplastic cutaneous manifestations: Concepts and updates. An Bras Dermatol 2013;88:9-22. DOI: 10.1590/S0365-05962013000100001.         [ Links ]

4. Gong J, Lim SW. Alopecia areata as a paraneoplastic syndrome of Hodgkin's lymphoma: A case report. Mol Clin Oncol 2014;2:596-8. DOI: 10.3892/mco.2014.274.         [ Links ]

5. Qiao J, Zhou G, Ding Y, et al. Multiple paraneoplastic syndromes: Myasthenia gravis, vitiligo, alopecia areata, and oral lichen planus associated with thymoma. J Neurol Sci 2011;308:177-9. DOI: 10.1016/ j.jns.2011.05.038.         [ Links ]