Case Number : Case 1909 - 21 Sept - Dr Hafeez Diwan Posted By: Guest

Hyperkeratosis, acanthosis, parakeratosis, apoptotic keratinocytes and metastatic cells in dermis. Acrokeratosis paraneoplastica or malignant acanthosis nigricans

Agree mostly with Anil. However, I do not see metastatic cells in the dermis and I thought we also see eccrine squamous syringometaplasia in the last four pictures? sunitinib (usually used for treating renal carcinoma) is frequently associated with this condition

Hyperkeratosis, acanthosis, parakeratosis, keratinocyte necrosis, and mild spongiosis accompanied by a hint of interface change.  Also, There is papillary dermal edema, and obvious syringosquamous metaplasia.

For me, chemotherapy-induced acral erythema with syringosquamous metaplasia is the best suggestion.

Glad to share the same thought with Raul. This is indeed a chemiotherapy (?sorafenib) hand foot syndrome for me (or something similar). Maybe a neutrophilic hidradenitis in the last 2 pictures, with , together to an obvious squamous syringometaplasia, is much consistent with PalmoPlantar Erythrodysestesia/Hand Foot syndrome. See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4071713/

and here

Changes highly suggestive of chemotherapy induced acral erythema. Both, eccrine squamous syringometaplasia and isolated necrotic keratinocytes (noted in this case) are present in CIAE.

Agree with CIAE

Indeed. This patient is on pazopanib, and the changes (squamous syringometaplasia, epidermal changes) are secondary to chemotherapy.