Journal List > J Korean Rheum Assoc > v.17(3) > 1003737

J Korean Rheum Assoc. 2010 Sep;17(3):272-277. Korean.
Published online September 30, 2010.  https://doi.org/10.4078/jkra.2010.17.3.272
Copyright © 2010 The Korean Rheumatism Association
A Case of Cutaneous Leukocytoclastic Vasculitis Presenting as the First Symptom of Adenosquamous Carcinoma of the Lung
Hyun-Ok Kim,1,4 Ho Cheol Kim,1,4 Gyung Hyuck Ko,2,4 Inseok Jang,3,4 Min Gyu Kang,1 Hyun Oh Park,3 Jian Hur,5 and Sang-Il Lee1,4
1Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea.
2Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea.
3Department of Chest Surgery, Gyeongsang National University School of Medicine, Jinju, Korea.
4Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
5Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

Corresponding author (Email: goldgu@gnu.ac.kr )
Received March 18, 2010; Revised April 16, 2010; Accepted April 20, 2010.

Abstract

Leukocytoclastic vasculitis (LV) is a systemic inflammatory disorder involving the small vessels. The exact cause of LV remains unknown, yet malignancy has been considered as a causative factor for LV. We experienced a 60-year-old male with purpura on his extremities. Computed tomography of the chest showed a mass lesion that was suspected to be a non-small-cell lung cancer and the biopsy revealed an adenosquamous carcinoma. There has been no report of LV associated with adenosquamous carcinoma of the lung in Korea. Thus, we report here on this case along with a review of the relevant articles.

Keywords: Leukocytoclastic vasculitis; Lung cancer; Adenosquamous carcinoma

Figures


Fig. 1
Purpuric lesions on the lower extremities.
Click for larger image


Fig. 2
(A) Chest PA shows fibrotic change with calcification in the right lung apical area and calcified pleural plaque in the left lower lung zone as the sequela of pulmonary tuberculosis. (B) Contrast enhanced CT shows about a 2 cm sized heterogeneous low attenuating mass lesion in the right lower lobe (posterior to the liver dome) (arrow).
Click for larger image


Fig. 3
(A) The dermal small vessels show swelling of the endothelial cells. The outline of the blood vessels appears indistinct due to the infiltration of inflammatory cells around the blood vessels (arrow). The infiltrate consists mainly of neutrophils and a small number of eosinophils and mononuclear cells. There is fragmentation of nuclei (leukocytoclasis) (dotted arrow). (B) The lung cancer shows components of both squamous cell carcinoma (arrow) and adenocarcinoma (dotted arrow) (Hematoxylin-Eosin Stain, A ×400, B ×100).
Click for larger image

Tables


Table 1
Cases of leukocytoclastic vasculitis with malignancy
Click for larger image

References
1. Gonzalez-Gay MA, Garcia-Porrua C, Pujol RM. Clinical approach to cutaneous vasculitis. Curr Opin Rheumatol 2005;17:56–61.
2. Cosar-Alas R, Yurut-Caloglu V, Karagol H, Caloglu M, Yalcin O, Turgut B, et al. Paraneoplastic syndrome of non-small cell lung carcinoma: a case with pancytopenia, leukocytoclastic vasculitis, and hypertrophic osteoarthropathy. Lung Cancer 2007;56:455–458.
3. Stashower ME, Rennie TA, Turiansky GW, Gilliland WR. Ovarian cancer presenting as leukocytoclastic vasculitis. J Am Acad Dermatol 1999;40:287–289.
4. Curgunlu A, Karter Y, Uyanik O, Tunckale A, Curgunlu S. Leukocytoclastic vasculitis and renal cell carcinoma. Intern Med 2004;43:256–257.
5. Odeh M, Misselevich I, Oliven A. Squamous cell carcinoma of the lung presenting with cutaneous leukocytoclastic vasculitis: a case report. Angiology 2001;52:641–644.
6. Lee JY, Jeong KH, Park M, Moon JY, Lee SH, Ihm CG, et al. Case of leukocytoclastic vasculitis associated with renal cell carcinoma. Korean J Nephrol 2007;26:762–766.
7. Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology 2010;56:3–23.
8. Zurada JM, Ward KM, Grossman ME. Henoch-schönlein purpura associated with malignancy in adults. J Am Acad Dermatol 2006;55:S65–S70.
9. Fain O, Hamidou M, Cacoub P, Godeau B, Wechsler B, Paries J, et al. Vasculitides associated with malignancies: Analysis of sixty patients. Arthritis Rheum 2007;57:1473–1480.
10. Pankhurst T, Savage CO, Gordon C, Harper L. Malignancy is increased in ANCA-associated vasculitis. Rheumatology (Oxford) 2004;43:1532–1535.
11. Carlson JA, Cavaliere LF, Grant-Kels JM. Cutaneous vasculitis: Diagnosis and management. Clin Dermatol 2006;24:414–429.
12. Naschitz JE, Yeshurun D, Eldar S, Lev LM. Diagnosis of cancer-associated vascular disorders. Cancer 1996;77:1759–1767.