P3161 - The Pseudo-Sign of Leser-Trélat: A Case Report of an Unusual Timeline Relationship

Jose W. Sotelo, MD¹, Pratyusha Tirumanisetty, MD², Sherif E. Elhanafi, MD¹, Marc Zuckerman, MD^1
1Texas Tech University Health Sciences Center, El Paso, TX; ²Brooklyn Hospital Center, Brooklyn, NY

Introduction: Leser-Trélat sign is a rare paraneoplastic syndrome characterized by the sudden onset of multiple seborrheic keratoses in association with an underlying malignancy, notably gastrointestinal adenocarcinoma, lymphoma, and breast cancer. Pseudo-sign of Leser-Trélat is an even rarer manifestation where multiple seborrheic keratoses appear without an underlying malignancy. Here, we report a case of pseudo-sign of Leser-Trélat that manifested 20 years before the diagnosis of colon cancer, thus suggesting a pseudo association.

Case Description/Methods: A 77-year-old male with a past medical history of hypertension was admitted for evaluation of generalized weakness and dizziness. He was hemodynamically stable upon presentation, and the physical examination was notable for numerous 2-10 mm waxy papules with a stuck-on appearance suggestive of seborrheic keratoses on his neck, chest, and back. Further workup revealed normocytic anemia with a hemoglobin level of 9.8 g/dL. Although Leser-Trélat sign was a concern, the patient mentioned that these lesions appeared suddenly over 20 years ago and had remained unchanged since then.

An abdominal ultrasound showed multiple echogenic lesions in the liver, suggestive of metastases. An MRI with a liver protocol confirmed the presence of multiple hepatic masses and a partially visualized mass in the proximal ascending colon, along with lymphadenopathy in the right lower quadrant and retroperitoneal area. Subsequent colonoscopy revealed a non-obstructing, fungating, infiltrative, partially circumferential mass in the proximal ascending colon. Biopsy confirmed the presence of adenocarcinoma. The patient was discharged home with plans for outpatient follow-up with Oncology for further management.

Discussion: This case highlights the importance of recognizing the long-term presence of seborrheic keratoses as a part of Leser-Trélat syndrome, indicating a high risk of future malignancy. It underscores the need for comprehensive evaluation and a screening strategy in such cases.



Disclosures:


Jose W. Sotelo, MD¹, Pratyusha Tirumanisetty, MD², Sherif E. Elhanafi, MD¹, Marc Zuckerman, MD¹. P3161 - The Pseudo-Sign of Leser-Trélat: A Case Report of an Unusual Timeline Relationship, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.