LAUSR

CLINICAL PRESENTATION A 63yearold man presented with an increasing number of pruritic, light to dark brown papules affecting his scalp, forehead and trunk (figure 1). The skin lesions started growing approximately 2 years prior. Clinical diagnosis of seborrhoeic keratoses (SK) was confirmed by histopathological examination (figure 2). Workup of new intermittent dragging pain localised on the lower right abdominal quadrant showed welldifferentiated neuroendocrine tumours (G1; somatostatin receptor 2a (SSTR2A) positive) of the ileum and the appendix. The ileum tumour had a diameter of 16 mm, with muscularis propria infiltration, invasion of lymphatic as well as blood vessels, and metastases in 3 out of 14 examined mesenteric lymph nodes (pT2pN2 (3/14) G1 L1 Pn0 R0). The appendix tumour had a diameter of 3 mm, muscularis propria infiltration and without vessel invasion (pT1a/pT1 G1 L0 V0 Pn0 R0). Immunohistochemical SK staining with SSTR2A was negative (figure 3). QUESTION What kind of paraneoplastic sign was encountered?