[Acral scleroderma presenting simultaneously with small-cell bronchial carcinoma: a paraneoplastic disease?].

The possible causal connection between systemic scleroderma and malignant neoplasms is a controversial issue. In the case of dermatomyositis, a malignant tumor is viewed as a possible trigger of the collagen disease; in contrast, scleroderma is suspected of causing tumors because of the long-term tissue fibrosis. A 68-year-old woman presented with acral scleroderma but already had metastatic bronchial carcinoma without evidence for previous pulmonary fibrosis. The rapid spread of the tumor and the sudden appearance of scleroderma suggest that in this case scleroderma could represent a paraneoplastic syndrome. Attention is directed to several growth factors and cytokines. On the one hand they play a part in the neoplastic transformation of the host cells and on the other hand they can change fibroblasts into a profibrotic phenotype and induce fibrosis. Impressive in this case is the fact that acral scleroderma definitely developed after the malignant tumor but before treatment, so that both fibrosis of the lung and side effects of chemotherapy and radiation can be excluded as triggers.