Tripe palm: a sinister marker of gastrointestinal malignancy

Sir, a 70-year-old male presented with progressive thickening and darkening of palms and soles for the past four months. Except for loss of appetite and mild weight loss, there were no other complaints. On examination, skin of both palms and soles showed diffuse hyperpigmentation and velvety thickening whereas skin over nape of neck and axilla were normal (Figure 1). Systemic examination revealed moderately enlarged and firm liver. Chest x-ray was normal. FNAC from the enlarged cervical lymph node revealed poorly differentiated adenocarcinoma suggestive of metastasis. Upper GI endoscopy detected a large, ulceroproliferative growth in the antrum of stomach. Histopathology showed a poorly differentiated adenocarcinoma (Figure 2).