A rare case of malignant acanthosis nigricans in a lady with ovarian cancer
A 47-year-old woman presented with progressive hyperpigmentation and hyperkeratosis of 14 months duration spreading from her face to the whole body []. She had a lower abdominal swelling which started 8 months back and on examination the mass was hard in consistency and arose from a pelvic organ. There were systemic symptoms of fatigue, weight loss, and night sweats over a period of 8 months. Investigations carried out by the oncologist revealed iron deficiency anemia (Hb 9.6 gm%, MCV 78 fl), an elevated alkaline phosphatase and reversal of albumin/globulin ratio in the liver function test. Her renal function test was within normal limits. Ultrasound-guided FNAC was done and cytopathology was suggestive of adenocarcinoma. Ultrasound examination of the abdomen showed a solid and cystic left ovarian mass, probably neoplastic. Spiral CT scan revealed a left ovarian complex cystic-solid mass suggestive of neoplastic mass []. Carcinoembryonic antigen levels were 35 times the normal value (1041 U/ml). Chest X ray was within normal limits. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was planned and she was referred to the dermatology department for an opinion before surgery as they wanted to exclude any skin infection and as a part of pre-operative work up. Staging of ovarian carcinoma according FIGO in our patient was stage IIIa and this staging is done after surgery. Chemotherapy was planned post-surgery. Physical examination also revealed hyperpigmented velvety plaques on her neck, axillae, abdomen, umbilicus and groins, and coarse-thickened palms and soles [Figures -].