Scientific letter
Psoriasiform lesions: Uncommon presentation of glucagonoma
Lesiones psoriasiformes: forma infrecuente de presentación de glucagonoma
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Psoriasiform lesions on the patient's legs before surgery, and two weeks after the intervention when the lesions were found to have disappeared.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Glucagonoma is a rare tumour of the alpha cells of the islets of both the body and tail of the pancreas. Approximately 70% are associated with glucagonoma syndrome, characterised by the development of necrolytic migratory erythema (NME), diabetes mellitus, weight loss, anaemia, diarrhoea, neuropsychiatric disorders and thromboembolic phenomena.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> NME is a rare skin condition, involving erythematous, pruritic, painful papules in the perineum and intertriginous areas. The papules group together forming plaques around a central blister. In 90% of cases, NME is associated with a glucagonoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The skin lesions can sometimes adopt a psoriasiform appearance, and the differential diagnosis between psoriasis and NME should be made in the case of widespread psoriasis which does not improve with sustained treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 52-year-old male investigated by dermatology for skin lesions. He was diagnosed with psoriasis vulgaris, but over the course of three years on treatment, without showing any improvement, he developed new lesions consisting of erythematous, erosive-crusted plaques on his lower limbs (particularly below the knees). A skin biopsy was requested as NME was suspected. The analysis showed psoriasiform dermatitis with compact parakeratosis and morphologically consistent subcorneal pustules and the patient was diagnosed with early-stage NME (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). An abdominal CT scan was performed, finding a 3.2-cm mass in the body of the pancreas with lymphadenopathy in the coeliac trunk of a significant size and multiple liver metastases affecting both lobes. Blood tests showed normal blood glucose, haemoglobin 12.3<span class="elsevierStyleHsp" style=""></span>g/dl (13.5–17.5), haematocrit 36% (41–53%), lutropin 12.5<span class="elsevierStyleHsp" style=""></span>mIU/ml (1.5–9.3), follitropin 5.9<span class="elsevierStyleHsp" style=""></span>mIU/ml (1.5–12.4), cortisol 14.3<span class="elsevierStyleHsp" style=""></span>μg/dl (6.2–19.4), somatotropin 1.3<span class="elsevierStyleHsp" style=""></span>ng/ml (<10.0), adrenocorticotropic hormone 87.8<span class="elsevierStyleHsp" style=""></span>pg/ml (<46.0), enolase 29<span class="elsevierStyleHsp" style=""></span>ng/ml (<16.0), beta-hCG 69<span class="elsevierStyleHsp" style=""></span>mIU/ml (<3.0) and carcinoembryonic antigen 1.4<span class="elsevierStyleHsp" style=""></span>ng/ml (<5.0). Investigations were completed with OctreoScan<span class="elsevierStyleSup">®</span> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), which showed a large mass in the body of the pancreas measuring approximately 3<span class="elsevierStyleHsp" style=""></span>cm, compatible with a glucagonoma, in addition to numerous areas of abnormal uptake of tracer in both lobes of the liver. Glucagonoma was diagnosed, which we decided to treat surgically, performing distal pancreatectomy with lymphadenectomy. The pathology report concluded that it was a well-differentiated G1 neuroendocrine tumour, compatible with glucagonoma of the body of pancreas, pT3 pN1. After surgery, the patient made good progress and, two weeks after the intervention, the skin lesions had completely disappeared (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). The patient is currently on treatment with lanreotide and is awaiting assessment for liver transplantation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pancreatic neuroendocrine tumours, of which glucagonoma represents 4%, account for 2% of all gastrointestinal tumours.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Glucagonoma is more common in females aged over 45. Approximately 50% of the patients diagnosed with these tumours develop clinical signs and symptoms related to the biological activity of the hormones secreted by the cancer. In patients with glucagonoma, 70–80% have the following triad: diabetes, NME and anaemia. Like other neuroendocrine tumours, glucagonomas express somatostatin receptors in more than 80% of cases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Glucagonomas can be detected by CT, MRI or ultrasound.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> As they express somatostatin receptors, scintigraphy with somatostatin analogues is used to demonstrate the presence of the cancer and the extent to which it may have spread.</p><p id="par0025" class="elsevierStylePara elsevierViewall">These tumours are slow-growing, with a high 10-year survival rate of over 50% in patients with metastasis, and around 65% in those without metastases. Mean survival is from three to seven years after diagnosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> The most effective treatment for NME is based on returning the glucagon levels to normal through surgical removal of the pancreatic tumour, as occurred with our patient. Surgical treatment is indicated in patients with disease limited to the pancreas, with or without lymphadenopathy, and for patients with liver or other potentially resectable metastases.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Over 50% of patients with clinical symptoms have liver metastases at the time of diagnosis. The surgical treatment of single liver metastasis has a 10-year survival rate of 60%. When the patient has liver metastases in both lobes with no extrahepatic disease and the tumour is resectable, liver transplantation with mean five-year survival of 40–81% may be indicated. If surgical treatment of metastases is contraindicated, chemoembolisation or radiofrequency ablation may be performed. Palliative treatment with somatostatin or its analogue (octreotide) achieves good results. These drugs reduce the conversion of proglucagon to glucagon, causing their levels to fall, achieving clinical improvement in many cases. Medical treatment with somatostatin analogues is considered the treatment of choice in cases of unresectable tumour. It also has benefits in the states of hormone overproduction (should be used in cases where the symptoms persist). The choice of treatment has to be made on an individual basis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, the spread of the tumour and the presence of metastases will determine the curative strategy to follow, with surgery being the technique of choice when the primary disease is under control and liver metastases (if any) are potentially resectable. Aggressive treatment of liver metastases seems to obtain better results in terms of the individual's survival. We believe it is important to stress that in the case of a psoriasiform lesion which does not respond to usual treatment, we should suspect a possible NME secondary to glucagonoma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Manzano Á, Balsalobre Salmerón MD, García López MA, Soto García S, Vázquez Rojas JL. Lesiones psoriasiformes: forma infrecuente de presentación de glucagonoma. Gastroenterol Hepatol. 2018;41:500–502.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 775 "Ancho" => 1200 "Tamanyo" => 134736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distal resection of pancreas and splenectomy. A firm whitish lesion with yellowish areas measuring 4.7<span class="elsevierStyleHsp" style=""></span>cm can be seen in the body of the pancreas.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1873 "Ancho" => 2334 "Tamanyo" => 1149927 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical study. CD56 positive. Chromogranin positive. Synaptophysin positive. Low Ki-67.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 646 "Ancho" => 1867 "Tamanyo" => 119085 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Preoperative OctreoScan<span class="elsevierStyleSup">®</span>. A 3-cm mass can be seen in the body of the pancreas with lymphadenopathy in the coeliac trunk and liver metastases in both lobes.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1761 "Ancho" => 2334 "Tamanyo" => 351648 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Necrolytic migratory erythema. Psoriasiform lesions on the patient's legs before surgery, and two weeks after the intervention when the lesions were found to have disappeared.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eritema necrolitico migratorio como síndrome de glucagonoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Ormaechea" 1 => "M. Arregui" 2 => "A. Lopez" 3 => "M. Lopez" 4 => "A. Jaka" 5 => "A. Tuneu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Cutan Iber Lat Am" "fecha" => "2013" "volumen" => "41" "paginaInicial" => "70" "paginaFinal" => "73" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review on surgery gastro-entero-pancreatic neuroendocrine tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Partelli" 1 => "A. Maurizi" 2 => "D. Taburrino" 3 => "A. Baldoni" 4 => "V. Polenta" 5 => "S. Crisppa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Endocrinol" "fecha" => "2014" "volumen" => "171" "paginaInicial" => "153" "paginaFinal" => "162" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0050" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical experience in diagnosis and treatment of glucagonoma syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Zhang" 1 => "X. Xu" 2 => "Y. Shen" 3 => "Z.H. Hu" 4 => "L. Wu" 5 => "S.S. Zheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hepatobiliary Pancreat Dis Int" "fecha" => "2004" "volumen" => "3" "paginaInicial" => "473" "paginaFinal" => "475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15313692" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0055" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in diagnosis and treatment of pancreatic neuroendocrine tumors (PNETS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.I. Vinik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/EP14373.RA" "Revista" => array:6 [ "tituloSerie" => "Endocr Pract" "fecha" => "2014" "volumen" => "20" "paginaInicial" => "1222" "paginaFinal" => "1230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25297671" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0060" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Pavel" 1 => "E. Baudin" 2 => "A. Couvelard" 3 => "E. Krenning" 4 => "K. Oberg" 5 => "T. Steinmuller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000335597" "Revista" => array:6 [ "tituloSerie" => "Neuroendocrinology" "fecha" => "2012" "volumen" => "95" "paginaInicial" => "157" "paginaFinal" => "176" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22262022" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of gastroenteropancreatic neuroendocrine tumours with octeotride LAR" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Tomassetti" 1 => "M. Migliori" 2 => "R. Corinaldesi" 3 => "L. Gullo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2000" "volumen" => "14" "paginaInicial" => "557" "paginaFinal" => "560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10792118" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Necrolytic migratory erythema as the first manifestation of pancreatic neuroendocrine tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.L. Wu" 1 => "J.G. Bai" 2 => "J. Xu" 3 => "Q.Y. Ma" 4 => "Z. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1477-7819-12-220" "Revista" => array:5 [ "tituloSerie" => "World J Surg Oncol" "fecha" => "2014" "volumen" => "12" "paginaInicial" => "220" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25029913" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004100000008/v1_201810020619/S2444382418301524/v1_201810020619/en/main.assets" "Apartado" => array:4 [ "identificador" => "48446" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004100000008/v1_201810020619/S2444382418301524/v1_201810020619/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382418301524?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 1 | 3 |
| 2024 October | 24 | 20 | 44 |
| 2024 September | 41 | 29 | 70 |
| 2024 August | 40 | 14 | 54 |
| 2024 July | 33 | 9 | 42 |
| 2024 June | 28 | 6 | 34 |
| 2024 May | 13 | 14 | 27 |
| 2024 April | 30 | 14 | 44 |
| 2024 March | 41 | 3 | 44 |
| 2024 February | 50 | 2 | 52 |
| 2024 January | 87 | 5 | 92 |
| 2023 December | 59 | 5 | 64 |
| 2023 November | 57 | 3 | 60 |
| 2023 October | 81 | 6 | 87 |
| 2023 September | 56 | 3 | 59 |
| 2023 August | 79 | 3 | 82 |
| 2023 July | 72 | 5 | 77 |
| 2023 June | 52 | 4 | 56 |
| 2023 May | 92 | 4 | 96 |
| 2023 April | 57 | 5 | 62 |
| 2023 March | 72 | 5 | 77 |
| 2023 February | 47 | 8 | 55 |
| 2023 January | 55 | 8 | 63 |
| 2022 December | 59 | 20 | 79 |
| 2022 November | 73 | 13 | 86 |
| 2022 October | 42 | 13 | 55 |
| 2022 September | 31 | 8 | 39 |
| 2022 August | 30 | 15 | 45 |
| 2022 July | 26 | 8 | 34 |
| 2022 June | 32 | 7 | 39 |
| 2022 May | 33 | 9 | 42 |
| 2022 April | 27 | 6 | 33 |
| 2022 March | 36 | 6 | 42 |
| 2022 February | 30 | 4 | 34 |
| 2022 January | 55 | 7 | 62 |
| 2021 December | 26 | 11 | 37 |
| 2021 November | 29 | 6 | 35 |
| 2021 October | 33 | 9 | 42 |
| 2021 September | 39 | 11 | 50 |
| 2021 August | 32 | 5 | 37 |
| 2021 July | 21 | 8 | 29 |
| 2021 June | 15 | 7 | 22 |
| 2021 May | 25 | 6 | 31 |
| 2021 April | 37 | 13 | 50 |
| 2021 March | 35 | 9 | 44 |
| 2021 February | 20 | 8 | 28 |
| 2021 January | 14 | 7 | 21 |
| 2020 December | 10 | 2 | 12 |
| 2020 November | 16 | 5 | 21 |
| 2020 October | 4 | 0 | 4 |
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