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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old woman presented with left hemithorax pain&#44; cough and weight loss of approximately 20<span class="elsevierStyleHsp" style=""></span>kg over a 4-month period&#46; She had a history of smoking &#40;40 packs&#47;year&#41; and chronic hypertension&#46; On physical examination&#44; she was eupneic on room air&#44; with normal pulmonary auscultation&#44; and presented left supraclavicular lymph-node enlargement&#46; Multiple brownish warty plaques with verrucous texture were present on the patient&#39;s skin&#59; they predominated in the anterior trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; with onset about 6 months previously&#46; The patient also reported mild signs and symptoms of dysphonia&#44; dysphagia and hoarseness&#46; Blood tests revealed mild anemia&#46; Other laboratory data were unremarkable&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Chest computed tomography showed an irregular mass in the anterior mediastinum&#44; in close contact with the aortic arch&#44; with heterogeneous contrast enhancement&#46; The mass infiltrate the left paratracheal space&#44; through the aortopulmonary window&#46; The left hemidiaphragm was elevated&#44; probably due to a phrenic nerve injury&#46; Lymph node enlargement was observed&#44; predominantly in the left supraclavicular region&#44; with necrotic centers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and D&#41;&#46; A biopsy of the supraclavicular lymph node with immunohistochemical study revealed a poorly differentiated malignant neoplasm compatible with thymic carcinoma&#46; The skin lesions were characterized as seborrheic keratoses&#46; Given these features&#44; a diagnosis of Leser-Tr&#233;lat sign was made&#46; The patient was referred for treatment of thymic carcinoma&#46; Her condition worsened&#44; and she died 2 months later&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seborrheic keratoses are benign dermatological lesions characterized by proliferation of immature keratinocytes&#44; which develop normally and gradually in some patients&#44; especially those in the fifth and sixth decades of life&#46; They present in well-defined&#44; rounded or ovoid shapes and they are hyperpigmented&#44; brownish or blackish with raised&#44; verrucous and wrinkled surfaces&#46; Preferred locations are the trunk&#44; extremities&#44; face and neck&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Leser-Tr&#233;lat sign refers to the sudden onset and rapid growth in number and size of multiple lesions of seborrheic keratoses&#44; sometimes associated with pruritus&#44; which precede&#44; succeed or occur concomitantly with a neoplasm&#44; whether hidden or known&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> About 20&#37; of patients present associated acanthosis nigricans&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Classically&#44; the sign is related to adenocarcinomas&#44; especially those of the gastrointestinal tract and breast&#44; but also those of the lung&#44; kidney&#44; liver&#44; pancreas&#44; ovary&#44; uterus and prostate&#44; as well as lymphoproliferative diseases&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> The pathophysiological mechanism is not completely understood&#44; but the sign is believed to be caused by cytokine stimuli&#44; growth or humoral factors produced by or in response to the tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Some authors have also reported associations with benign conditions&#44; such as pregnancy and some benign tumors&#46; Histopathological findings are similar to those of usual seborrheic keratosis&#46; No specific treatment is available for the lesions&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> but regression occurs with treatment of the underlying disease in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; the sudden onset and rapid growth of eruptive seborrheic keratoses &#40;Leser-Tr&#233;lat sign&#41; may lead to the early diagnosis of an occult cancer&#46; These lesions may coincide with the diagnosis of cancer&#44; or follow or precede it by months or years&#46;</p></span>"
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Scientific letter
Leser-Trélat Sign Secondary to Thymic Carcinoma
Signo de Leser-Trélat secundario a carcinoma tímico
Gustavo Braga Mendes, Gláucia Zanetti, Edson Marchiori
Corresponding author
edmarchiori@gmail.com

Corresponding author.
Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old woman presented with left hemithorax pain&#44; cough and weight loss of approximately 20<span class="elsevierStyleHsp" style=""></span>kg over a 4-month period&#46; She had a history of smoking &#40;40 packs&#47;year&#41; and chronic hypertension&#46; On physical examination&#44; she was eupneic on room air&#44; with normal pulmonary auscultation&#44; and presented left supraclavicular lymph-node enlargement&#46; Multiple brownish warty plaques with verrucous texture were present on the patient&#39;s skin&#59; they predominated in the anterior trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; with onset about 6 months previously&#46; The patient also reported mild signs and symptoms of dysphonia&#44; dysphagia and hoarseness&#46; Blood tests revealed mild anemia&#46; Other laboratory data were unremarkable&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Chest computed tomography showed an irregular mass in the anterior mediastinum&#44; in close contact with the aortic arch&#44; with heterogeneous contrast enhancement&#46; The mass infiltrate the left paratracheal space&#44; through the aortopulmonary window&#46; The left hemidiaphragm was elevated&#44; probably due to a phrenic nerve injury&#46; Lymph node enlargement was observed&#44; predominantly in the left supraclavicular region&#44; with necrotic centers &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and D&#41;&#46; A biopsy of the supraclavicular lymph node with immunohistochemical study revealed a poorly differentiated malignant neoplasm compatible with thymic carcinoma&#46; The skin lesions were characterized as seborrheic keratoses&#46; Given these features&#44; a diagnosis of Leser-Tr&#233;lat sign was made&#46; The patient was referred for treatment of thymic carcinoma&#46; Her condition worsened&#44; and she died 2 months later&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seborrheic keratoses are benign dermatological lesions characterized by proliferation of immature keratinocytes&#44; which develop normally and gradually in some patients&#44; especially those in the fifth and sixth decades of life&#46; They present in well-defined&#44; rounded or ovoid shapes and they are hyperpigmented&#44; brownish or blackish with raised&#44; verrucous and wrinkled surfaces&#46; Preferred locations are the trunk&#44; extremities&#44; face and neck&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Leser-Tr&#233;lat sign refers to the sudden onset and rapid growth in number and size of multiple lesions of seborrheic keratoses&#44; sometimes associated with pruritus&#44; which precede&#44; succeed or occur concomitantly with a neoplasm&#44; whether hidden or known&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a> About 20&#37; of patients present associated acanthosis nigricans&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Classically&#44; the sign is related to adenocarcinomas&#44; especially those of the gastrointestinal tract and breast&#44; but also those of the lung&#44; kidney&#44; liver&#44; pancreas&#44; ovary&#44; uterus and prostate&#44; as well as lymphoproliferative diseases&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> The pathophysiological mechanism is not completely understood&#44; but the sign is believed to be caused by cytokine stimuli&#44; growth or humoral factors produced by or in response to the tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Some authors have also reported associations with benign conditions&#44; such as pregnancy and some benign tumors&#46; Histopathological findings are similar to those of usual seborrheic keratosis&#46; No specific treatment is available for the lesions&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> but regression occurs with treatment of the underlying disease in some cases&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion&#44; the sudden onset and rapid growth of eruptive seborrheic keratoses &#40;Leser-Tr&#233;lat sign&#41; may lead to the early diagnosis of an occult cancer&#46; These lesions may coincide with the diagnosis of cancer&#44; or follow or precede it by months or years&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Photograph showing multiple eruptive seborrheic keratoses in the patient&#39;s trunk&#46; &#40;B&#41; Axial&#44; &#40;C&#41; coronal and &#40;D&#41; sagittal computed tomography images showing a heterogeneous mass in the anterior mediastinum in close contact with aorta&#44; partially compressing the left pulmonary artery&#46; The mass also infiltrate the left paratracheal space&#44; through the aortopulmonary window&#44; determining elevation of the left hemidiaphragm&#44; probably due to a phrenic nerve injury&#46; Left necrotic supraclavicular lymph-node enlargement &#40;arrows&#41; is also visible&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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