Acrokeratosis paraneoplastica with hepatoid adenocarcinoma of the lung : a rare case report

Acrokeratosis paraneoplastica with hepatoid adenocarcinoma of the lung : a rare case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Acrokeratosis paraneoplastica with hepatoid adenocarcinoma of the lung : a rare case report Ikrame BEJJA, Hanane BAYBAY, Sara ELLOUDI, Meryem SOUGHI, Zakia DOUHI, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5145859/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background acrokeratosis paraneoplastica, also known as Bazex syndrome, is a rare acral psoriasiform dermatosis closely associated with squamous cell carcinoma, especially in the upper respiratory and gastrointestinal tracts. Case presentation : in this case, we will discuss the case of a patient presenting with chronic palmoplantar keratoderma with psoriasiform appearance revealing a hepatoid adenocarcinoma of the lung. Conclusions only a few cases of Bazex's paraneoplastic acrokeratosis have been published, and they are frequently associated with squamous cell carcinoma of the upper aerodigestive tract. The association with this histological variety, hepatoid adenocarcinoma, has never been reported. acrokeratosis paraneoplastica Bazex lung hépatoid adenocarcinoma Figures Figure 1 Figure 2 Background Acrokeratosis paraneoplastica (APB) is an uncommon dermatological disorder classified as an obligatory paraneoplastic dermatosis. First described by Bazex in 1965 as the « paraneoplastic syndrome with hyperkeratosis of the extremities ». It was observed in a patient with pyriform sinus cancer and cervical metastases, with cutaneous lesions regressing following tumor treatment [ 1 ]. Since then, all documented cases of Bazex syndrome in the literature have been associated with an underlying neoplasm. The most commonly linked neoplasms include squamous cell carcinoma of the upper aerodigestive tract and other tumors presenting with cervical or mediastinal lymph node metastases. Additionally, various other associated neoplasms have been reported, including gastric adenocarcinoma, colon adenocarcinoma, small cell lung carcinoma, lung adenocarcinoma, hematological malignancies, cutaneous squamous cell carcinoma, and urogenital tumors [ 2 ]. Here, we present the case of a patient diagnosed with hepatoid adenocarcinoma of the lung after evaluation for lesions consistent with acrokeratosis paraneoplastica. Case presentation A 64-year-old chronic smoker and tobacco sniffer, presented with thick, pruritic lesions on the palms and soles for the past 8 months. He was treated with topical medications, resulting in partial improvement, but the lesions recurred upon cessation, accompanied by weight loss, anorexia, and fatigue. This cutaneous symptomatology was preceded by a productive cough without hemoptysis two years earlier. Clinical examination revealed a cachectic patient with focal fissured palmoplantar keratoderma (Fig. 1 (a,b)) and evident xerosis, without clinical signs of a tumoral syndrome. The differential diagnoses considered included Bazex paraneoplastic acrokeratosis, mycosis fungoides, palmoplantar psoriasis, or chronic contact dermatitis. Skin biopsy revealed dyskeratosis with spongiosis associated with a dense inflammatory dermal infiltrate predominantly lymphocytic. A chest X-ray revealed a right paracardiac opacity with blurred spiral boundaries and mediastinal widening, prompting referral to the pulmonology department. A thoracic computer tomography scan showed an irregularly contoured, enhancing intraparenchymal mass in the lower right lobe measuring 5*2cm, with multiple suspicious bilateral parenchymal and subpleural micromodules. Subsequently, bronchoscopy with biopsy revealed hepatoid adenocarcinoma on histological and immunohistochemical analysis. A positron emission tomography (PET) scan with 18-fluorodeoxyglucose (18F-FDG) for staging demonstrated multiple distant secondary lesions, predominantly in the bones and lungs, leading to referral to the oncology department for further management. Dermatologically, the patient was treated with 10% salicylic acid vaseline and potent topical corticosteroids, resulting in moderate improvement of his keratoderma (Fig. 2). Discussion Bazex syndrome is an obligatory paraneoplastic dermatosis with a pathophysiological mechanism that remains poorly understood, although alcohol and tobacco consumption are identified as the primary risk factors. It precedes the diagnosis of the neoplasm in 67% of cases and develops after diagnosis in 15% of cases. It often affects individuals in middle age, between the 4th and 7th decade, with a clear male predominance [ 3 ]. Clinical presentations encompass reddish to purplish psoriasiform patches with poorly defined borders, displaying a distinctive symmetric, bilateral, and acral distribution. It typically progresses through three stages [ 4 ]: Stage 1: Initial presentation involves symmetrical invasion of the ear helices, nose, fingers, and toes. Early lesions are flat with indistinct borders, occasionally displaying crusts and scaling, typically without associated symptoms except for pruritus, which is commonly reported. Stage 2: As the underlying malignancy progresses, potentially leading to local or metastatic spread, a more widespread eruption of the skin occurs. Characteristic red to purple scaly or crusted plaques develop on the cheeks, with scaling appearing on the palms and soles, excluding the central areas. Fissures, mainly on the feet, and nail involvement such as subungual hyperkeratosis, onycholysis, longitudinal streaks, and yellow discoloration may cause discomfort and functional impairment. Stage 3: This final phase corresponds to untreated or treatment-resistant carcinoma. Existing signs and symptoms persist, while papulosquamous lesions start to appear on the trunk, elbows, knees, and dorsal aspects of the hands and feet. Occasionally, vesicles and bullae may arise, particularly on the fingers, hands, and feet. Histological features of APB are unspecific with spongiosis, hyperkeratosis and areas of parakeratosis, interface change including vacuolar degeneration and dyskeratotic keratinocytes, and in the dermis, a lymphohistiocytic inflammatory infiltrate and papillary dermal fibrosis [ 5 ]. The underlying cause of Bazex syndrome remains unclear. Some researchers have suggested an immunological mechanism based on the presence of immunoglobulins (IgG, IgM, IgA) and complement (C3) along the basal membrane in both affected and unaffected skin. Others have noted that serum levels of squamous cell carcinoma antigen (SCC-Ag) correlate with the severity of skin lesions in certain patients, further supporting the involvement of an immunological process. Additionally, the co-occurrence of Bazex syndrome with other autoimmune conditions like vitiligo and alopecia areata has led to speculation about an autoimmune mechanism [ 2 ]. It is often associated with squamous cell carcinoma of the upper aerodigestive tract. However, its association with the hepatoid adenocarcinoma (ADC) of the lung has never been described. This histological subtype constitutes an uncommon malignant tumor primarily found in the stomach. It has also been documented to arise from other organs such as the bladder, pancreas, and ovary. When this liver-like ADC develops in the lung, it is termed hepatoid adenocarcinoma of the lung (HAL), which represents a small proportion (2.3%) of all hepatoid ADC cases and is associated with a dismal prognosis. [ 6 ], Treatment of the underlying tumor can lead to a reduction or disappearance of the cutaneous signs of APB. Otherwise, other treatments may improve it such as topical or systemic steroids, oral psoralen-UVA phototherapy, and retinoids [ 4 ]. When Bazex syndrome is suspected, the initial step in evaluation, and perhaps the most crucial, involves conducting a comprehensive medical history and physical examination to guide further diagnostic tests. A standard workup typically includes a thorough otolaryngological examination, chest X-rays, complete blood count, erythrocyte sedimentation rate, biochemical profile (including iron studies), tumor markers, and stool occult blood testing. If the ear, nose, and throat examination and chest X-rays yield no significant findings, additional investigations may entail upper gastrointestinal endoscopy. In the presence of anemia or occult blood in stool, colonoscopy should be considered. Depending on clinical history and physical examination findings, imaging studies such as chest, abdominal, or pelvic scans may be warranted. If all tests come back negative, the patient should be evaluated every three months with a detailed medical history and thorough clinical examination, including otolaryngological assessment, along with basic laboratory tests [ 2 ]. Our case is an unusual case, firstly due to the clinical presentation solely involving the palms and soles, which allowed the diagnosis of hepatoid adenocarcinoma of the lung despite being revealed at the metastatic stage. Conclusion In summary, Bazex syndrome presents a unique challenge due to its association with underlying malignancies. Understanding this relationship is essential for early detection and appropriate management. Further research is needed to explore the pathophysiological mechanisms linking these conditions and to improve diagnostic and therapeutic strategies. Abbreviations APB : Acrokeratosis paraneoplastica HAL : hepatoid adenocarcinoma of the lung 18F-FDG :18-fluorodeoxyglucose ADC : hepatoid adenocarcinoma Declarations Acknowledgements Not applicable. Authors’ contributions IB wrote the initial draft of the manuscript. HB and FZ.M managed the diagnosis and treatment. ZD, MS, SE and FZ.M approved the final version of the manuscript and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript. Funding The study received no external funding. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request Ethics approval and consent to participate Verbal informed consent was obtained from the patient for publication of this case report. Consent for publication Verbal consent was obtained from the patient for publication of this case report and any accompanying images Competing interests The authors declare that they have no competing interests. References Bazex A, Salvador R, Dupré A, Parant M, Christol B, Cantala P, Carles P. (1967). Dermatose psoriasiforme acromélique d’étiologie cancéreuse. Bull Soc Fr Derm Syph 74:130-5. Valdivielso, M., Longo, I., Suárez, R., Huerta, M., & Lázaro, P. (2005). Acrokeratosis paraneoplastica (Bazex syndrome). Journal of the European Academy of Dermatology and Venereology 19 : 340-344. Eckstein J, Healy E, Jain A, Hawkins D, Ho QA, Agrawal A, Ozer E, Rupert R, Diavolitsis VM, Bhatt AD. (2020). A series of typical and atypical cases of Bazex syndrome: Identifying the red herring to avoid delaying cancer treatment. Clin Case Rep. 8 :2259-2264. SHAH, Muhammad Hamza, FERRAZZANO, Carlo, KARTHIKEYAN, Anhukrisha, et al. (2023) Bazex Syndrome (Acrokeratosis Paraneoplastica): A Narrative Review of Pathogenesis, Clinical Manifestations, and Therapeutic Approaches. Cureus. 15, e45368. Pulickal JK, Kaliyadan F. Acrokeratosis Paraneoplastica. (2023). In: StatPearls. Treasure Island (FL). PMID: 29083711. Lei L, Yang L, Xu YY, Chen HF, Zhan P, Wang WX, Xu CW. (2021). Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database. Open Med (Wars). 16:169-174. doi: 10.1515/med-2021-0215. PMID: 33585692; PMCID: PMC7863000 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5145859","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":460394511,"identity":"c1faee1b-1ec7-4def-b794-e3c72f5b2085","order_by":0,"name":"Ikrame BEJJA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACNh4Yi70BSBhYkKKF5wBIiwQR1sC1SCSAScI6+HjOPvx0o4JB3nzm86sbfhRIMPC3dyfgdxhvu7F0zhkGwzm3c8pu9gAdJnHm7Ab8WvjZGKRz2xgYZ0jnpN3gAWoxkMglqIX5d+4/BvsZkmfSbv4hSgtvG5t0bgND4gwJ9mO3ibOF5xibdc4xieQZPDlst2UMJHgI+kW+J435dk6Nje0M9uPPbr75YyPH396LXwsUgKKDxwDE4iGgEgWwPyBF9SgYBaNgFIwgAADcZTy8bJ9w1QAAAABJRU5ErkJggg==","orcid":"","institution":"Hassan II University Hospital, FEZ","correspondingAuthor":true,"prefix":"","firstName":"Ikrame","middleName":"","lastName":"BEJJA","suffix":""},{"id":460394512,"identity":"7762ec23-719e-4dc7-bf35-0a73ee48ecd1","order_by":1,"name":"Hanane BAYBAY","email":"","orcid":"","institution":"Hassan II University Hospital, FEZ","correspondingAuthor":false,"prefix":"","firstName":"Hanane","middleName":"","lastName":"BAYBAY","suffix":""},{"id":460394513,"identity":"fb5db79b-adf2-46a6-ab25-28df925f70e8","order_by":2,"name":"Sara ELLOUDI","email":"","orcid":"","institution":"Hassan II University Hospital, FEZ","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"","lastName":"ELLOUDI","suffix":""},{"id":460394514,"identity":"c6592980-2b04-4777-8b6e-7c4a4f103ab4","order_by":3,"name":"Meryem SOUGHI","email":"","orcid":"","institution":"Hassan II University Hospital, FEZ","correspondingAuthor":false,"prefix":"","firstName":"Meryem","middleName":"","lastName":"SOUGHI","suffix":""},{"id":460394515,"identity":"8823a626-a34b-46ca-bbb1-55ee2e368678","order_by":4,"name":"Zakia DOUHI","email":"","orcid":"","institution":"Hassan II University Hospital, FEZ","correspondingAuthor":false,"prefix":"","firstName":"Zakia","middleName":"","lastName":"DOUHI","suffix":""},{"id":460394516,"identity":"878806d0-8eca-4e32-bead-2c59aedba344","order_by":5,"name":"Fatima Zahrae MERNISSI","email":"","orcid":"","institution":"Hassan II University Hospital, FEZ","correspondingAuthor":false,"prefix":"","firstName":"Fatima","middleName":"Zahrae","lastName":"MERNISSI","suffix":""}],"badges":[],"createdAt":"2024-09-24 14:23:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5145859/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5145859/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83438656,"identity":"dd3b08c3-90d3-420a-a318-08fd09d5d9e7","added_by":"auto","created_at":"2025-05-26 09:04:55","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":475673,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure1ab.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5145859/v1/944cb78a1d4f11c395a95d20.jpg"},{"id":83438655,"identity":"d26cc6d2-023d-4c2b-9ce5-40b53881ebfd","added_by":"auto","created_at":"2025-05-26 09:04:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":68633,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5145859/v1/e8f9665ffd5731ddac254671.jpg"},{"id":83438658,"identity":"7520f4a9-1c2b-48d5-a253-14d5e2305c93","added_by":"auto","created_at":"2025-05-26 09:05:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":902745,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5145859/v1/1c24a5ed-f18b-4b80-b30c-ce3a0a52f40d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Acrokeratosis paraneoplastica with hepatoid adenocarcinoma of the lung : a rare case report","fulltext":[{"header":"Background","content":"\u003cp\u003eAcrokeratosis paraneoplastica (APB) is an uncommon dermatological disorder classified as an obligatory paraneoplastic dermatosis. First described by Bazex in 1965 as the \u0026laquo; paraneoplastic syndrome with hyperkeratosis of the extremities \u0026raquo;. It was observed in a patient with pyriform sinus cancer and cervical metastases, with cutaneous lesions regressing following tumor treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Since then, all documented cases of Bazex syndrome in the literature have been associated with an underlying neoplasm. The most commonly linked neoplasms include squamous cell carcinoma of the upper aerodigestive tract and other tumors presenting with cervical or mediastinal lymph node metastases. Additionally, various other associated neoplasms have been reported, including gastric adenocarcinoma, colon adenocarcinoma, small cell lung carcinoma, lung adenocarcinoma, hematological malignancies, cutaneous squamous cell carcinoma, and urogenital tumors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Here, we present the case of a patient diagnosed with hepatoid adenocarcinoma of the lung after evaluation for lesions consistent with acrokeratosis paraneoplastica.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 64-year-old chronic smoker and tobacco sniffer, presented with thick, pruritic lesions on the palms and soles for the past 8 months. He was treated with topical medications, resulting in partial improvement, but the lesions recurred upon cessation, accompanied by weight loss, anorexia, and fatigue. This cutaneous symptomatology was preceded by a productive cough without hemoptysis two years earlier. Clinical examination revealed a cachectic patient with focal fissured palmoplantar keratoderma (Fig.\u0026nbsp;1 (a,b)) and evident xerosis, without clinical signs of a tumoral syndrome. The differential diagnoses considered included Bazex paraneoplastic acrokeratosis, mycosis fungoides, palmoplantar psoriasis, or chronic contact dermatitis. Skin biopsy revealed dyskeratosis with spongiosis associated with a dense inflammatory dermal infiltrate predominantly lymphocytic. A chest X-ray revealed a right paracardiac opacity with blurred spiral boundaries and mediastinal widening, prompting referral to the pulmonology department. A thoracic computer tomography scan showed an irregularly contoured, enhancing intraparenchymal mass in the lower right lobe measuring 5*2cm, with multiple suspicious bilateral parenchymal and subpleural micromodules. Subsequently, bronchoscopy with biopsy revealed hepatoid adenocarcinoma on histological and immunohistochemical analysis. A positron emission tomography (PET) scan with 18-fluorodeoxyglucose (18F-FDG) for staging demonstrated multiple distant secondary lesions, predominantly in the bones and lungs, leading to referral to the oncology department for further management. Dermatologically, the patient was treated with 10% salicylic acid vaseline and potent topical corticosteroids, resulting in moderate improvement of his keratoderma (Fig.\u0026nbsp;2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBazex syndrome is an obligatory paraneoplastic dermatosis with a pathophysiological mechanism that remains poorly understood, although alcohol and tobacco consumption are identified as the primary risk factors. It precedes the diagnosis of the neoplasm in 67% of cases and develops after diagnosis in 15% of cases. It often affects individuals in middle age, between the 4th and 7th decade, with a clear male predominance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinical presentations encompass reddish to purplish psoriasiform patches with poorly defined borders, displaying a distinctive symmetric, bilateral, and acral distribution. It typically progresses through three stages [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003eStage 1: Initial presentation involves symmetrical invasion of the ear helices, nose, fingers, and toes. Early lesions are flat with indistinct borders, occasionally displaying crusts and scaling, typically without associated symptoms except for pruritus, which is commonly reported.\u003c/p\u003e \u003cp\u003eStage 2: As the underlying malignancy progresses, potentially leading to local or metastatic spread, a more widespread eruption of the skin occurs. Characteristic red to purple scaly or crusted plaques develop on the cheeks, with scaling appearing on the palms and soles, excluding the central areas. Fissures, mainly on the feet, and nail involvement such as subungual hyperkeratosis, onycholysis, longitudinal streaks, and yellow discoloration may cause discomfort and functional impairment.\u003c/p\u003e \u003cp\u003eStage 3: This final phase corresponds to untreated or treatment-resistant carcinoma. Existing signs and symptoms persist, while papulosquamous lesions start to appear on the trunk, elbows, knees, and dorsal aspects of the hands and feet. Occasionally, vesicles and bullae may arise, particularly on the fingers, hands, and feet.\u003c/p\u003e \u003cp\u003eHistological features of APB are unspecific with spongiosis, hyperkeratosis and areas of parakeratosis, interface change including vacuolar degeneration and dyskeratotic keratinocytes, and in the dermis, a lymphohistiocytic inflammatory infiltrate and papillary dermal fibrosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe underlying cause of Bazex syndrome remains unclear. Some researchers have suggested an immunological mechanism based on the presence of immunoglobulins (IgG, IgM, IgA) and complement (C3) along the basal membrane in both affected and unaffected skin. Others have noted that serum levels of squamous cell carcinoma antigen (SCC-Ag) correlate with the severity of skin lesions in certain patients, further supporting the involvement of an immunological process. Additionally, the co-occurrence of Bazex syndrome with other autoimmune conditions like vitiligo and alopecia areata has led to speculation about an autoimmune mechanism [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is often associated with squamous cell carcinoma of the upper aerodigestive tract. However, its association with the hepatoid adenocarcinoma (ADC) of the lung has never been described. This histological subtype constitutes an uncommon malignant tumor primarily found in the stomach. It has also been documented to arise from other organs such as the bladder, pancreas, and ovary. When this liver-like ADC develops in the lung, it is termed hepatoid adenocarcinoma of the lung (HAL), which represents a small proportion (2.3%) of all hepatoid ADC cases and is associated with a dismal prognosis. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e],\u003c/p\u003e \u003cp\u003eTreatment of the underlying tumor can lead to a reduction or disappearance of the cutaneous signs of APB. Otherwise, other treatments may improve it such as topical or systemic steroids, oral psoralen-UVA phototherapy, and retinoids [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen Bazex syndrome is suspected, the initial step in evaluation, and perhaps the most crucial, involves conducting a comprehensive medical history and physical examination to guide further diagnostic tests. A standard workup typically includes a thorough otolaryngological examination, chest X-rays, complete blood count, erythrocyte sedimentation rate, biochemical profile (including iron studies), tumor markers, and stool occult blood testing. If the ear, nose, and throat examination and chest X-rays yield no significant findings, additional investigations may entail upper gastrointestinal endoscopy. In the presence of anemia or occult blood in stool, colonoscopy should be considered. Depending on clinical history and physical examination findings, imaging studies such as chest, abdominal, or pelvic scans may be warranted.\u003c/p\u003e \u003cp\u003eIf all tests come back negative, the patient should be evaluated every three months with a detailed medical history and thorough clinical examination, including otolaryngological assessment, along with basic laboratory tests [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur case is an unusual case, firstly due to the clinical presentation solely involving the palms and soles, which allowed the diagnosis of hepatoid adenocarcinoma of the lung despite being revealed at the metastatic stage.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, Bazex syndrome presents a unique challenge due to its association with underlying malignancies. Understanding this relationship is essential for early detection and appropriate management. Further research is needed to explore the pathophysiological mechanisms linking these conditions and to improve diagnostic and therapeutic strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPB\u0026nbsp;: Acrokeratosis paraneoplastica\u003c/p\u003e\n\u003cp\u003eHAL\u0026nbsp;: hepatoid adenocarcinoma of the lung\u003c/p\u003e\n\u003cp\u003e18F-FDG :18-fluorodeoxyglucose\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eADC : hepatoid adenocarcinoma\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIB wrote the initial draft of the manuscript. HB and FZ.M managed the diagnosis and treatment. ZD, MS, SE and FZ.M approved the final version of the manuscript and agreed to be accountable for all aspects of the work. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal informed consent was obtained from the patient for publication of this case report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVerbal consent was obtained from the patient for publication of this case report and any accompanying images\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBazex A, Salvador R, Dupré A, Parant M, Christol B, Cantala P, Carles P. (1967). Dermatose psoriasiforme acromélique d\u0026rsquo;étiologie cancéreuse. Bull Soc Fr Derm Syph 74:130-5.\u003c/li\u003e\n\u003cli\u003eValdivielso, M., Longo, I., Su\u0026aacute;rez, R., Huerta, M., \u0026amp; L\u0026aacute;zaro, P. (2005). Acrokeratosis paraneoplastica (Bazex syndrome). Journal of the European Academy of Dermatology and Venereology 19 : 340-344.\u003c/li\u003e\n\u003cli\u003eEckstein J, Healy E, Jain A, Hawkins D, Ho QA, Agrawal A, Ozer E, Rupert R, Diavolitsis VM, Bhatt AD. (2020). A series of typical and atypical cases of Bazex syndrome: Identifying the red herring to avoid delaying cancer treatment. Clin Case Rep. 8 :2259-2264. \u003c/li\u003e\n\u003cli\u003eSHAH, Muhammad Hamza, FERRAZZANO, Carlo, KARTHIKEYAN, Anhukrisha, et al. (2023) Bazex Syndrome (Acrokeratosis Paraneoplastica): A Narrative Review of Pathogenesis, Clinical Manifestations, and Therapeutic Approaches. Cureus. 15, e45368.\u003c/li\u003e\n\u003cli\u003ePulickal JK, Kaliyadan F. Acrokeratosis Paraneoplastica. (2023). In: StatPearls. Treasure Island (FL). PMID: 29083711.\u003c/li\u003e\n\u003cli\u003eLei L, Yang L, Xu YY, Chen HF, Zhan P, Wang WX, Xu CW. (2021). Hepatoid adenocarcinoma of the lung: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database. Open Med (Wars). 16:169-174. doi: 10.1515/med-2021-0215. PMID: 33585692; PMCID: PMC7863000\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"acrokeratosis paraneoplastica, Bazex, lung, hépatoid adenocarcinoma","lastPublishedDoi":"10.21203/rs.3.rs-5145859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5145859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eacrokeratosis paraneoplastica, also known as Bazex syndrome, is a rare acral psoriasiform dermatosis closely associated with squamous cell carcinoma, especially in the upper respiratory and gastrointestinal tracts.\u003c/p\u003e\u003ch2\u003eCase presentation :\u003c/h2\u003e \u003cp\u003ein this case, we will discuss the case of a patient presenting with chronic palmoplantar keratoderma with psoriasiform appearance revealing a hepatoid adenocarcinoma of the lung.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eonly a few cases of Bazex's paraneoplastic acrokeratosis have been published, and they are frequently associated with squamous cell carcinoma of the upper aerodigestive tract. The association with this histological variety, hepatoid adenocarcinoma, has never been reported.\u003c/p\u003e","manuscriptTitle":"Acrokeratosis paraneoplastica with hepatoid adenocarcinoma of the lung : a rare case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 09:04:50","doi":"10.21203/rs.3.rs-5145859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f0c485d-dc87-4aa5-b6f1-f33b14300a23","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-26T09:04:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 09:04:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5145859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5145859","identity":"rs-5145859","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}