{"ops":[{"insert":"A 73-year-old woman presents with a three-month history of multiple scaly, reddish patches on both hands and feet. She has also lost seven kilograms of weight during the same duration. Further questioning reveals anorexia and mild dysphagia to solids alone, also for the same time period.\n\nHer medical and dermatological histories are unremarkable. Her surgical history is only significant for an uncomplicated vaginal hysterectomy performed at age 63. She is a heavy smoker, with around 50 pack-years of exposure.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-M-270_en.png"}},{"insert":"\n"}]}
2
Investigate
Skin biopsy
{"ops":[{"insert":"Multiple skin biopsies are obtained from the erythematous patches and plaques. All of these only show nonspecific findings including acanthosis, hyperkeratosis, parakeratosis and perivascular infiltration of lymphocytes and histiocytes, with vacuolar degeneration.\n"}]}
Upper GI Endoscopy
{"ops":[{"insert":"There is thickening of the stomach walls and loss of the normal rugal folds from the gastroesophageal junction to the antrum. Multiple biopsies are obtained; histopathological analysis is positive for gastric adenocarcinoma.\n"}]}
