[en] Introduction: We report the case of a patient who had a paraneoplastic syndrome as the first manifestation of a head and neck squamous cell carcinoma. Materials and methods: A 57-year-old man was admitted to the pulmonology department due to long-standing dyspnea along with bilateral pleural effusion and arthritis in knees, carpus and metacarpae of recent appearance. During his hospitalization he presents erythema and desquamation in the hands, auricular pavilions, knees and thighs; A minimal pericardial effusion was also observed. The autoimmunity analysis revealed positive antinuclear antibodies and Anti Ro positive, being the rest of the tests normal. The skin lesions are diagnosed as Acrokeratosis Paraneoplastica (Basex s?ndrome). The physical examination of the patient revealed the presence of a hard and adherent right cervical mass, not showing pharyngolaryngeal lesions or in other locations. A puncture with thick needle of cervical mass is performed, being the result of anatomopathological analysis squamous cell carcinoma. The mass is classified as cervical metastasis of unknown origin. Discussion: The systemic clinical manifestations by the metabolites of tumors are called paraneoplastic syndromes. The different metabolites produced can cause a wide range of symptoms, usually mediated by the toxic action of substances released by the tumor. They usually affect several organs and systems: endocrine, dermatological, ocular and osteoarticular. Paraneoplastic syndromes occur in 1 to 7.4% of all cancer patients, with presentation in infrequent head and neck neoplasms. Squamous cell carcinoma is the variant most frequently associated with this type of syndromes, also frequently occurring in neuroendocrine tumors, with a lower incidence in other types of tumors such as adenocarcinoma, adenoid cystic carcinoma, lymphomas and sarcomas. Basex Acrokeratosis Paraneoplastica was first described in 1965, being associated with carcinoma of the piriformis sinus. Clinically, it is characterized by erythematous desquamative skin patches with a predilection in the extremities and is the paraneoplastic syndrome that occurs most frequently in tumors of the larynx and hypopharynx. Conclusion: Physicians treating cancer patients should be able to differentiate paraneoplastic syndromes from other benign disorders; These syndromes can dominate the clinical picture of the patient leading to a diagnostic delay since this symptom eclipses the underlying oncological pathology. The paraneoplastic syndromes are important because they allow an early diagnosis and an adequate treatment of the patient's tumor

[es] Introducci?n y objetivo: Presentamos el caso de una paciente que present? un s?ndrome paraneopl?sico como primera manifestaci?n de un carcinoma epidermoide. Materiales y M?todos: Var?n de 57 a?os de edad, que es ingresado en el servicio de neumolog?a por presentar disnea de larga evoluci?n junto a derrame pleural bilateral y artritis en rodillas, carpos y metacarpos de reciente aparici?n. Durante su hospitalizaci?n presenta eritema y descamaci?n en manos, pabellones auriculares, rodillas y muslos; se objetiv? tambi?n un m?nimo derrame peric?rdico. La anal?tica de autoinmunidad revelo anticuerpos antinucleares positivos y Anti Ro positivo, siendo el resto de pruebas normales. Las lesiones cut?neas son diagnosticadas como queratosis paraneopl?sica de Basex. La exploraci?n f?sica del paciente revel? la presencia de una masa cervical derecha dura y adherida, no objetiv?ndose lesiones faringolar?ngeas ni en otras localizaciones. Se realiza una punci?n con aguja gruesa de la masa cervical, siendo el resultado del an?lisis anatomopatol?gico carcinoma epidermoide. La lesi?n es catalogada como met?stasis cervical de or?gen desconocido. Discusi?n: Las manifestaciones cl?nicas sist?micas por los metabolitos de los tumores son denominadas s?ndromes paraneopl?sicos. Las diferentes metabolitos producidos pueden provocar un amplio abanico de s?ntomas, generalmente mediados por la acci?n toxica de las sustancias liberadas por el tumor. Suelen afectar varios ?rganos y sistemas: endocrinos, dermatol?gicos, oculares y osteoarticulares. Los s?ndromes paraneopl?sicos ocurren en el 1 a 7,4% de todos los pacientes con c?ncer, siendo la presentaci?n en las neoplasias de cabeza y cuello infrecuente. El carcinoma epidermoide es la variante asociada con m?s frecuencia a este tipo de s?ndromes, tambi?n present?ndose con frecuencia en tumores neuroendocrinos, siendo menor la incidencia en otro tipo de tumores como el adenocarcinoma, carcinoma adenoide qu?stico, linfomas y sarcomas. La acroqueratosis paraneopl?sica de Basex, fue descrita por primera vez en 1965, siendo asociada a carcinoma del seno piriforme. Cl?nicamente se caracteriza por placas cut?neas descamativas eritematosas con predilecci?n en extremidades y es el s?ndrome paraneopl?sico que se presenta m?s frecuentemente en los tumores de laringe e hipofaringe. Conclusi?n: Los facultativos que tratan pacientes oncol?gicos deben ser capaces de diferenciar los s?ndromes paraneopl?sicos de otros des?rdenes benignos; estos s?ndromes pueden dominar el cuadro cl?nico del paciente llevando a una demora diagn?stica puesto que esta sintomatolog?a eclipsa la patolog?a oncol?gica de base. El conocimiento de los s?ndromes paraneopl?sicos es importante porque permite orientar el caso correctamente, para de esta manera realizar un diagn?stico precoz y un tratamiento orientado a la patolog?a del paciente.