NEJM Audio Summary - Jan 26, 2012

Excerpted Script

The "Images in clinical medicine" features a 56-year-old female smoker who presented with cough, a weight loss of 27 kg over a period of 6 months, and diffuse bone pain. The palms had a raised velvety texture, and there was digital clubbing. There was a fixed, tender lump on the right lower leg and one over the lower lumbar spine. There was also a nodule in the left breast. A CT scan of the chest showed a mass in the upper lobe of the right lung . A bone scan showed areas of uptake that were consistent with metastases, as well as diffuse linear uptake in the femoral and tibial bones, consistent with hypertrophic pulmonary osteoarthropathy . Examination of specimens obtained by CT-guided biopsy of the lung mass and fine-needle aspiration of the breast nodule were consistent with large-cell adenocarcinoma. Hypertrophic pulmonary osteoarthropathy and tripe palms (acanthosis palmaris) are paraneoplastic manifestations of, most frequently, lung and gastric carcinomas.

今回は、"Images in clinical medicine"から、"tripe palms"というのが初耳だったので。この言葉は、Clarke J.が1977年に使い始めて、acanthosis palmaris、pachydermato-glyphy、palmar hyperkeratosis、palmarkeratoderma、acanthosis nigricans of the palmなどと同意語とのこと。"tripe"ってのは、牛の反芻胃であるハチノスのことで、イタリアでもトリッパ(trippa)を使う料理があるらしい。