Urothelial and Renal Papillary Carcinomas Presenting as Paraneoplastic Florid Cutaneous Papillomatosis

Case Report

Ann Hematol Oncol. 2015; 2(9): 1063.

Urothelial and Renal Papillary Carcinomas Presenting as Paraneoplastic Florid Cutaneous Papillomatosis

Samhouri Y¹, Samudrala G¹ and Ban-Hoefen M²*

¹Department of Internal Medicine, Rochester Regional Health-Unity Hospital, USA

²Department of Interlakes Oncology and Hematology, University of Rochester, USA

*Corresponding author: Ban-Hoefen M, Department of Interlakes Oncology and Hematology, University of Rochester, 211 White Spruce Blvd, Rochester, NY 14623, USA

Received: October 01, 2015; Accepted: November 10,2015; Published: November 15, 2015


Florid Cutaneous Papillomatosis (FCP) is a rare paraneoplastic syndrome similar to Malignant Acanthosis Nigricans and sign of Leser-Trélat. FCP is well associated with gastric adenocarcinoma. We report a rare case of FCP and malignant acanthosis nigricans as presenting signs that led to the diagnosis of three different malignancies, namely, urothelial cancer, renal papillary carcinoma and conjunctival carcinoma in-situ in a patient with Phosphatase Tensin (PTEN) germline mutation. FCP presents as eruptions of 1-3 mm diameter wart-like nodules on the hands, feet and face. Sudden onset of similar diffuse cutaneous lesions should elicit serious consideration for paraneoplastic disease and further workup to evaluate for an underlying cancer. This case adds to sparse literature on FCP and highlights their importance as paraneoplastic markers.

Keywords: Florid cutaneous papillomatosis; Renal papillary carcinoma; PTEN; Paraneoplastic


FCP: Florid Cutaneous Papillomatosis; PTEN: Phosphatase and Tensin Homolog

Case Presentation

A 55 year old gentleman with hypertension, an excellent performance status and working full time as an electrical engineer, developed hematuria and diffuse skin eruptions over a month’s time. The patient has a very strong family history of malignancies. His Mother had breast cancer at age of 40, his father had bladder cancer at age of 70 and his paternal aunt had colon cancer. On physical exam, he had innumerable verrucous and filiform fleshy white hyperkeratotic papillomas over the face (Figure 1), neck and arms that spared the palms. Both conjunctivae were erythematous. Perianal skin was papillomatous with velvety hyper-pigmented area (Figure 2). The remainder of the physical exam was unremarkable. Complete blood count and chemistries were normal. CT scan of chest, abdomen and pelvis revealed enhancing lesions within the right collecting system and right retroperitoneal and aortocaval lymphadenopathy, in addition to a 4.8 cm mass in the upper pole of the left kidney (Figure 3). Biopsy of the three regions revealed right kidney invasive urothelial carcinoma, right retroperitoneal metastatic urothelial carcinoma and left kidney renal papillary neoplasm. The conjunctival biopsy showed carcinoma in-situ. He was started on neoadjuvant chemotherapy with Gemcitabine and Cisplatin. After two cycles of chemotherapy, there was significant improvement in the rash (Figure 4). After 4 cycles of chemotherapy, imaging revealed improvement in the number and dimensions of lymph nodes, stable size of the left renal mass, and shrinkage of the right collecting system mass. He subsequently underwent a right nephroureterectomy and retroperitoneal lymph node dissection. Unfortunately, the papillomas reappeared three months after the surgery. CT scan of the abdomen and pelvis showed new retroperitoneal lymphadenopathy. Core biopsy of these lymph nodes confirmed urothelial carcinoma.