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© 2001 American Society for Clinical Oncology
Skin Lesions in MalignancyCase 3. Yellow Nail Syndrome in Non-Hodgkin's LymphomaArthur T. Skarin MD EDITOR’S NOTE: PNET VERSUS pPNET The January 1, 2001, Diagnosis in Oncology article entitled "Case 1. Sucking and Recovery After Brain Surgery" (J Clin Oncol 19:273-274, 2001) featured a 12-month-old girl with primitive neuroectodermal tumor (PNET) of the posterior fossa. This tumor, also called a medulloblastoma, occurs often in children but rarely in adults. It should not be confused with a peripheral primitive neuroectodermal tumor (pPNET) of the Ewing’s sarcoma family.Consulting Editor Diagnosis in Oncology
Centre Hospitalier Lyon Sud, Pierre-Benite, FranceCopyright © 2001 American Society of Clinical Oncology A 61-year-old white male was referred because of abdominal lymphadenopathy. He had a 2-year history of yellow discoloration of all of his nails on his feet and hands ( Fig 1). Furthermore, he had hypertension, myocardiopathy, and chronic bronchitis with acute flares for 2 years. An abdominal computed tomography scan showed the presence of retroperitoneal and left iliac lymphadenopathy. The thoracic computed tomography scan showed no lymphadenopathy, but bronchiectasis with bronchial wall thickening and bronchial dilation were present in both lower lobes. After an abdominal lymph node biopsy was performed, a diagnosis of B-cell lymphoma was made. The patient was treated with eight cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone. After the first cycle, the proximal halves of the fingernails had become clear, whereas the distal halves were still yellowish and thickened ( Fig 2). After four cycles of chemotherapy, complete regression of lymphoma occurred and was associated with a normal appearance of all of the nails ( Figs 3 and 4). However, the patient relapsed 4 months after the end of chemotherapy and died of disease 3 months later. The yellow nails had begun to recur.
The full-blown yellow nail syndrome (YNS) is characterized by the triad of arrested nail growth, chronic respiratory disorders, and dysplasia of the nail lymphatics.1,2 However, most cases are monosymptomatic, exhibiting only characteristic alterations of all nails: excessively curved nail from side to side and pale yellow to slightly green color.2 The pathogenesis of YNS is obscure. Anatomic dysplasia of the lymph vessels may account for both lymphedema and respiratory infections but does not explain the altered nail growth.1 Some authors have reported drug-induced YNS3 as well as AIDS-associated YNS.4 Neoplasia has been associated with this syndrome.5-8 YNS and non-Hodgkin’s lymphoma have been reported in only one case described, in which nail appearance of a patient with mycosis fungoides did not improve despite a remission of the hematologic malignancy.9 In summary, our case adds further support to the association between malignancy and YNS as a paraneoplastic syndrome. REFERENCES 1. Samman PD, White WF: The "yellow nail" syndrome. Br J Dermatol 76: 153-157, 1964[Medline] 2. Venecie PY, Dicken CH: Yellow nail syndrome: Report of five cases. J Am Acad Dermatol 10: 187-192, 1984[Medline] 3. Ishizaki C, Sueki H, Kohsokabe S, et al: Yellow nail induced by bucillamine. Int J Dermatol 34: 493-494, 1995[Medline] 4. Chernosky ME, Finley VK: Yellow nail syndrome in patients with acquired immunodeficiency disease. J Am Acad Dermatol 13: 731-736, 1985[Medline] 5. Burrows NP, Jones RR: Yellow nail syndrome in association with carcinoma of the gall bladder. Clin Exp Dermatol 16: 471-473, 1991[Medline] 6. Thomas PS, Sidhu B: Yellow nail syndrome and bronchial carcinoma. Chest 92: 191, 1987 7. Mambretti-Zumwalt J, Seidman JM, Higano N: Yellow nail syndrome: Complete triad with pleural protein turnover studies. South Med J 73: 995-997, 1980[Medline]
8.
Iqbal M, Rossof LJ, Marzouk KA, et al: Resolution of yellow nails after successful treatment of breast cancer. Chest 117: 1516-1518, 2000 9. Stosiek N, Peters KP, Hiller D, et al: Yellow nail syndrome in a patient with mycosis fungoides. J Am Acad Dermatol 28: 792-794, 1993[Medline]
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Copyright © 2001 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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