|
1
|
Muluken Y, Taye B, Gezehegne H, Fikre D, Tilahun M, Muluken S, Fikre D, Shumiye Y, Solomon H, Essa S. Bronchogenic carcinoma metastasis to first metacarpal bone: A rare case report. Radiol Case Rep 2025; 20:3471-3475. [PMID: 40385507 PMCID: PMC12084393 DOI: 10.1016/j.radcr.2025.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 04/05/2025] [Accepted: 04/07/2025] [Indexed: 05/20/2025] Open
Abstract
Metastasis accounts for the majority of malignant bone tumors in adults. The commonly involved bones are pelvis, spine and proximal long bone. Metastasis below elbow and knee joint is rare. Metastasis to the hand is very rare, when they occur the commonest sites are distal phalanges. Lung cancer is the commonest primary to metastasize to the hand. Here we present a 51-year-old male known lung cancer (adenocarcinoma of the lung) patient for whom lobectomy was done and put on adjuvant chemotherapy latter presented with long standing left thumb pain and swelling, initially treated with antipain with a diagnostic impression of tenosynovitis. Ultrasound guided core needle biopsy was taken and metastatic adenocarcinoma infiltration confirmed. Hand metastasis is usually mistaken for inflammatory or infectious conditions, so what we wanted to highlight in this case report is although hand metastasis is very rare it should be considered in patients with long standing pain and swelling especially if there is any primary tumor even if its remote. In few cases it can also be an initial presentation.
Collapse
Affiliation(s)
- Yenewub Muluken
- Department of Radiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Bement Taye
- Department of Radiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Hiwot Gezehegne
- Department of Radiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Dagmawit Fikre
- Department of Radiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Mesay Tilahun
- Department of Radiology, College of Health Sciences, Addis Ababa University, Ethiopia
| | | | - Daniel Fikre
- Lideta Health Center, Addis Ababa Health Bureau, Ethiopia
| | - Yonas Shumiye
- Department of Pathology, College of Heath Sciences, Addis Ababa University, Ethiopia
| | - Henock Solomon
- Department of Pathology, College of Heath Sciences, Addis Ababa University, Ethiopia
| | - Suleman Essa
- Department of Pathology, College of Heath Sciences, Addis Ababa University, Ethiopia
| |
Collapse
|
|
2
|
Petrova K, Gaydarski L, Simeonov R, Tsvetanov L, Landzhov B, Georgiev GP. Uncommon Manifestations of Lung Cancer: Diagnostic Challenges and Valuable Insights From a Rare Clinical Case. Cureus 2024; 16:e71249. [PMID: 39525166 PMCID: PMC11550511 DOI: 10.7759/cureus.71249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2024] [Indexed: 11/16/2024] Open
Abstract
Lung cancer is commonly diagnosed at advanced stages, often presenting with metastases. Although bone metastases are common in lung cancer patients, acrometastases - metastatic lesions in the bones of the hand - are exceedingly rare. Herein, we report the case of a 71-year-old male with previously undiagnosed lung adenocarcinoma, which first manifested as a painful swelling in the right hand. Radiographic imaging and biopsy revealed a bone metastasis involving the third metacarpal and phalanges, secondary to lung adenocarcinoma. Three weeks after the biopsy, the hand tumor became severely ulcerated, leading to a significant drop in hemoglobin levels, necessitating an urgent amputation as a life-saving measure. This case highlights the diagnostic challenges of rare metastatic patterns and emphasizes the need for timely and accurate diagnosis to improve outcomes. Clinicians should consider metastases in the differential diagnosis of unexplained hand swelling, and early intervention is critical in managing such aggressive cases.
Collapse
Affiliation(s)
- Kristina Petrova
- Department of Clinical Laboratory, Medical University of Sofia, Sofia, BGR
| | - Lyubomir Gaydarski
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
| | - Radoil Simeonov
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Sofia, BGR
| | - Lubomir Tsvetanov
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Sofia, BGR
| | - Boycho Landzhov
- Department of Anatomy, Histology and Embryology, Medical University of Sofia, Sofia, BGR
| | - Georgi P Georgiev
- Department of Orthopaedics and Traumatology, University Hospital Queen Giovanna - ISUL, Sofia, BGR
| |
Collapse
|
|
3
|
Dow T, Davis C, ElAbd R, Lalonde D, Williams J. Cancer Metastases to the Hand: A Systematic Review and Meta-analysis. Hand (N Y) 2024; 19:865-874. [PMID: 36856295 PMCID: PMC11342693 DOI: 10.1177/15589447231153175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. METHODS An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. RESULTS Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. CONCLUSION Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.
Collapse
Affiliation(s)
- Todd Dow
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada
| | - Caitlin Davis
- Department of Obstetrics and Gynecology, Dalhousie Unviersity, Halifax, NS, Canada
| | - Rawan ElAbd
- Division of Plastic and Reconstructive Surgery, McGill Univeristy, Montreal, Canada
- Division of Plastic and Reconstructive Surgery, Jaber Al Ahmed Al Jaber Al Sabah Hopsital, Surra, Kuwait
| | - Donald Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, NB, Canada
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
|
4
|
Luther L, McGlone PJ, Hardacker KD, Alsoof D, Hayda RA, Terek RM. Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report. Orthop Rev (Pavia) 2024; 16:91505. [PMID: 38469575 PMCID: PMC10927312 DOI: 10.52965/001c.91505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/03/2023] [Indexed: 03/13/2024] Open
Abstract
Case A 62-year-old woman presenting with ankle pain was initially treated for a non-displaced fracture. Persistent pain despite months of conservative management for her presumed injury prompted repeat radiographs which demonstrated the progression of a lytic lesion and led to an orthopedic oncology referral. Following a complete work-up, including biopsy and staging, she was diagnosed with colorectal carcinoma metastatic to the distal fibula. Conclusion Secondary tumors of the fibula are uncommon but an important diagnosis to consider for intractable lower extremity pain especially in patients with history of malignancy or lack of age-appropriate cancer screening.
Collapse
Affiliation(s)
| | | | | | - Daniel Alsoof
- Corresponding Author: Daniel Alsoof Department of Orthopaedic Surgery Brown University, Warren Alpert School of Medicine 1 Kettle Point Avenue Providence, RI 02906
| | | | | |
Collapse
|
|
5
|
Wu J, Zhou Y, Yang D, Yang F. A rare presentation of lung squamous cell carcinoma metastasis to the distal phalanx of the little finger: a case report. CANCER INNOVATION 2022; 1:194-196. [PMID: 38090652 PMCID: PMC10686163 DOI: 10.1002/cai2.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/29/2022] [Accepted: 05/28/2022] [Indexed: 10/15/2024]
Abstract
Lung cancer is one of the most common malignant tumors worldwide. Early detection is the most important factor that affects the prognosis of lung cancer patients. The distal phalanx is a highly unusual metastatic site of lung cancer, and is often misdiagnosed, especially when accompanied by trauma. Herein, we present the case of a 68-year-old male patient who injured his right little finger. We hope this rare case will help clinicians to better diagnosis acral metastases of lung cancer to prolong patient survival.
Collapse
Affiliation(s)
- Jianjun Wu
- Department of CardiologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
- Key Laboratory of Myocardial Ischemia, Ministry of EducationHarbin Medical UniversityHarbinChina
| | - Yinan Zhou
- Department of Digestive Internal MedicineThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Dawei Yang
- Department of OrthopedicsThe Fourth Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Fan Yang
- Department of CardiologyThe Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
- Key Laboratory of Myocardial Ischemia, Ministry of EducationHarbin Medical UniversityHarbinChina
| |
Collapse
|
|
6
|
Bilateral Hand Metastases From a Pleomorphic/Dedifferentiated Leiomyosarcoma: A Case Report. Am J Dermatopathol 2021; 44:118-120. [PMID: 34783705 DOI: 10.1097/dad.0000000000002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Leiomyosarcomas of the lower extremity are heterogeneous tumors with high recurrence and metastasizing rates, which, rarely, can suffer a dedifferentiation process, making them extremely aggressive and unpredictable. We report the case of a 72-year-old female patient who presented the clinical and histopathological features of a rare leiomyosarcoma of the foot that was completely excised, but because of the interruption of adjuvant oncological treatment and lack of compliance for the follow-up, the patient suffered a dedifferentiation process and the tumor metastasized in the fingers-an unprecedented site for this type. The present case proves the fact that there is still a lot we do not know about the behavior of this disease, and there is always room to learn. Also, through this report, we are emphasizing a frequently encountered and never-ending problem in our country-that of difficult and resource-consuming cases derived from disconsidering medical advice by noncompliant patients when faced with a malignant diagnosis, making all attempts to offer them a better quality of life futile.
Collapse
|
|
7
|
Sebghati J, Khalili P, Tsagkozis P. Surgical treatment of metastatic bone disease of the distal extremities. World J Orthop 2021; 12:743-750. [PMID: 34754830 PMCID: PMC8554352 DOI: 10.5312/wjo.v12.i10.743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/16/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Metastatic bone disease of the distal extremities, also known as acrometastasis, is very rare. Thus, there is very limited information regarding the clinical manifestations and methods of surgical treatment. The current available literature shows that acrometastases are often encountered in the context of advanced disease and are thus associated with poor patient survival. As metastatic bone disease is generally uncurable, the goal of surgical treatment is to provide the patient with good function with as few complications as possible. In this article, we discuss the clinical manifestation of acrometastases, the methods of surgical intervention, and the expected clinical outcome. Non-surgically managed pathological fractures generally remain ununited; therefore, conservative treatment is reserved for patients with poor general condition or dismal prognosis. The current evidence suggests that in lesions of the lower arm and leg, osteosynthesis (plate and screw fixation or intramedullary nail) is the most common method of reconstruction, whereas local excision or amputation are more commonly used in cases of more distal lesions (such as ankle, foot and hand). Following surgery most patients receive adjuvant radiotherapy, even though its role is poorly documented. Close collaboration between orthopedic surgeons and medical oncologists is necessary to improve patient care and treatment outcome. Further studies are needed in order to provide stronger clinical evidence and improve decision-making, in an effort to optimize the patients’ quality of life and avoid the need for revision surgery.
Collapse
Affiliation(s)
| | - Pendar Khalili
- Department of Orthopedics, Central Hospital in Karlstad, Karlstad 65230, Sweden
| | - Panagiotis Tsagkozis
- Department of Orthopedic Surgery, Karolinska University hospital, Solna 17176, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna 17176, Sweden
| |
Collapse
|
|
8
|
Cottignoli C, Romagnolo C, Fringuelli FM, Burroni L. Lung cancer metastasis mimicking fingertip osteomyelitis: An 18F-fluorodeoxyglucose positron emission tomography-computed tomography study. World J Nucl Med 2021; 20:185-187. [PMID: 34321972 PMCID: PMC8286004 DOI: 10.4103/wjnm.wjnm_70_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 11/04/2022] Open
Abstract
Lung cancer commonly metastasizes to ipsilateral and contralateral lungs, to mediastinal lymph nodes, to skeletal level, to brain, and to adrenal gland. It is indeed very rare to find skeletal metastases at the extremities, especially at the onset of the disease. We share the case of a 53-year-old man with dyspnea and pain at the level of the first finger of the left hand under antibiotic treatment for suspected osteomyelitis. 18F-fluorodeoxyglucose positron emission tomography-computed tomography showed the presence of a left lung lesion with multiple localizations at muscles and bones.
Collapse
Affiliation(s)
- Chiara Cottignoli
- Department of Nuclear Medicine, "Ospedali Riuniti" Hospital, Ancona, Italy
| | - Cinzia Romagnolo
- Department of Nuclear Medicine, "Ospedali Riuniti" Hospital, Ancona, Italy
| | | | - Luca Burroni
- Department of Nuclear Medicine, "Ospedali Riuniti" Hospital, Ancona, Italy
| |
Collapse
|
|
9
|
Abstract
Most tumors of the hand and the wrist are benign; however, malignant conditions can mimic benign tumors and must be worked up accordingly.
Advanced imaging should be followed by biopsy before definitive treatment of tumors of unknown diagnosis. The most common soft-tissue masses in the hand and the wrist are ganglion cysts, whereas the most common bone tumors are enchondromas.
Collapse
Affiliation(s)
- Sophia A Strike
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark E Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| |
Collapse
|
|
10
|
Isomura ET, Hamaguchi M, Nishimura N, Ushimura A, Namikawa M. Metastasis to the finger of oral floor squamous cell carcinoma: A case report. Clin Case Rep 2021; 9:8-11. [PMID: 33489126 PMCID: PMC7813014 DOI: 10.1002/ccr3.3344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/24/2022] Open
Abstract
When cetuximab is used, diagnosing finger metastasis can be difficult due to the side effects of paronychia and color changes of nails. Finger metastasis may be a marker of multiple metastasis; therefore, it can lead to a poor prognosis.
Collapse
Affiliation(s)
- Emiko Tanaka Isomura
- First Department of Oral and Maxillofacial SurgeryGraduate School of DentistryOsaka UniversitySuitaJapan
| | - Munehiro Hamaguchi
- Yao Municipal Hospital Department of Oral and Maxillofacial SurgeryYaoJapan
| | - Nao Nishimura
- Yao Municipal Hospital Department of Oral and Maxillofacial SurgeryYaoJapan
| | - Ayako Ushimura
- Yao Municipal Hospital Department of Oral and Maxillofacial SurgeryYaoJapan
| | - Mari Namikawa
- First Department of Oral and Maxillofacial SurgeryGraduate School of DentistryOsaka UniversitySuitaJapan
| |
Collapse
|
|
11
|
Çiftdemir M, Ustabaşıoğlu FE, Çölbe SA, Üstün F, Usta U, Çiçin İ. Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: A retrospective study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:67-72. [PMID: 33650515 DOI: 10.5152/j.aott.2020.20052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the clinical, pathological, and prognostic characteristics of acral metastases in patients with malignant disease and to determine the impact of different types of acral metastasis treatment on patient survival. METHODS In this retrospective study, 64 acral metastatic lesions in 46 patients (17 women, 29 men; mean age, 61.5 years; age range, 35-82 years) who were evaluated by the Bone and Soft Tissue Tumors Council of our institute from 2015 to 2019 were included. The patients' primary tumor site, tumor type, localization of acral metastases, main symptom, duration from the diagnosis of the primary tumor to the diagnosis of acral metastasis, duration from the diagnosis of acral metastasis to death, and survival data were analyzed. The diagnosis of acral metastasis was confirmed by histopathological evaluation in 38 patients and clinical and radiological assessment of the lesions in 8 patients. The treatment type for each acral metastasis was individualized by the institutional Bone and Soft Tissue Tumors Council and categorized into 3 groups: excisional surgery (amputations and resections), palliative surgery (prophylactic fixation, intralesional curettage, and bone cement augmentation), and non-surgical treatment (chemotherapy, radiotherapy, and hormone therapy). RESULTS A total of 16 acral metastases (25%) were identified in the upper extremity and 48 (75%) in the lower extremity. The most common primary tumor site was the lungs (32.6%), and the most common tumor type was adenocarcinoma (43.2%). The most frequent symptom and the primary reason for admission was pain (58.7%). The mean duration between the diagnosis of primary tumor and the diagnosis of acral metastasis was 19.1 (range, 0-124) months. No significant correlation was determined between the primary tumor types and duration from the diagnosis of primary tumor to the diagnosis of acral metastasis (p=0.278). Acral metastases were treated by excisional surgery in 15 (32.6%) patients, palliative surgery combined with non-surgical treatment in 10 (21.7%) patients, and only non-surgical treatment modalities in 21 (45.7%) patients. No significant correlation existed between the treatment types and patient survival (p=0.058). At the final follow-up, 30 (65.2%) patients were dead owing to the disease. The mean overall survival of the entire study group was 24.9 (range, 3-55) months. The mean duration between the diagnosis of acral metastasis and death was 7.6 (range, 3-24) months in patients who were dead owing to the disease (p=0.012). CONCLUSION When the diagnosis of acral metastasis is established, it should be borne in mind that the most common primary tumor site and type are most likely the lungs and adenocarcinoma, respectively. The treatment type for acral metastasis may have no significant impact on patient survival, but the extensiveness of the disease may be a critical factor for survival. LEVEL OF EVIDENCE Level IV, Prognostic study.
Collapse
Affiliation(s)
- Mert Çiftdemir
- Department of Orthopedics and Traumatology, Trakya University, School of Medicine, Edirne, Turkey
| | | | - Süleyman Alp Çölbe
- Department of Orthopedics and Traumatology, Trakya University, School of Medicine, Edirne, Turkey
| | - Funda Üstün
- Department of Nuclear Medicine, Trakya University, School of Medicine, Edirne, Turkey
| | - Ufuk Usta
- Department of Pathology, Trakya University, School of Medicine, Edirne, Turkey
| | - İrfan Çiçin
- Department of Medical Oncology, Trakya University, School of Medicine, Edirne, Turkey
| |
Collapse
|
|
12
|
Kraleti S, Manyam S, Dawson K. Giant cell tumor of the bone presenting as swelling of the thumb. Proc (Bayl Univ Med Cent) 2020; 34:307-308. [PMID: 33678973 DOI: 10.1080/08998280.2020.1840182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
We describe a giant cell tumor in a 74-year-old man who presented with pain and swelling in the left thumb. Radiographs of the left hand showed some lytic changes at the tip of the thumb. Magnetic resonance imaging suggested the diagnosis of giant cell tumor, which was later confirmed by biopsy. A good treatment response was achieved with disarticulation of the interphalangeal joint and amputation of the distal phalanx of the left thumb.
Collapse
Affiliation(s)
- Shashank Kraleti
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Swapna Manyam
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Kellen Dawson
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
|
13
|
Ehne J, Tsagozis P. Current concepts in the surgical treatment of skeletal metastases. World J Orthop 2020; 11:319-327. [PMID: 32908816 PMCID: PMC7441493 DOI: 10.5312/wjo.v11.i7.319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients’ quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.
Collapse
Affiliation(s)
- Jessica Ehne
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
| | - Panagiotis Tsagozis
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
| |
Collapse
|
|
14
|
Gallardo-Alvarado L, Ramos AA, Perez-Montiel D, Ramirez-Morales R, Diaz E, Leon DCD. Hand metastasis in a patient with cervical cancer: A case report. Medicine (Baltimore) 2020; 99:e20897. [PMID: 32629680 PMCID: PMC7337540 DOI: 10.1097/md.0000000000020897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Acrometastasis is infrequent and generally indicates a wider spread of metastasis with poor prognosis. The diagnosis is challenging, as it might mimic an infectious, inflammatory, or metabolic disease. Acrometastasis are most commonly found in patients with lung, gastrointestinal, kidney, and breast cancer. Only 3 cases of cervical cancer associated with hand metastasis have been reported in the literature. PATIENT CONCERNS Herein, we report a 58-year-old patient with locally advanced cervical cancer and recurrence in the right thumb as presentation of widespread disseminated disease. She initially presented with adenocarcinoma of the uterine cervix and was treated with concurrent chemoradiation followed by high-dose rate brachytherapy. Six months later, she developed an insidious onset of pain and swelling in the right thumb, erythema, and edema, mimicking cellulitis. DIAGNOSIS A biopsy of the soft tissues of the thumb was performed, and the histopathology indicated metastasis of adenocarcinoma to the bone and soft tissues. INTERVENTIONS AND OUTCOMES The patient rejected further treatment and died of progressive disease 4 months after the diagnosis of the recurrence. CONCLUSION Metastases in unusual sites are a diagnostic challenge, and there is no standardized treatment. Timely diagnosis and treatment can improve the prognosis of these patients and might preserve their quality of life.
Collapse
Affiliation(s)
| | - Alma Astorga Ramos
- Medical Oncology Department, Mexican Institute of Social Security, Coahuila
| | | | | | - Erick Diaz
- Department of Clinical Research, National Cancer Institute
| | - David Cantu-de Leon
- Department of Clinical Research, National Cancer Institute
- Department of Gynecology, National Cancer Institute, Mexico City, Mexico
| |
Collapse
|
|
15
|
Afrăsânie VA, Adavidoaiei AM, Zamisnicu IH, Funingănă IG, Marinca MV, Gafton B, Clement DE, Păduraru MI, Demşa I, Miron L, Alexa-Stratulat T. A very rare presentation of lung cancer: Metastases to the distal phalanx of index-case report. Medicine (Baltimore) 2019; 98:e17892. [PMID: 31804306 PMCID: PMC6919407 DOI: 10.1097/md.0000000000017892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Acrometastases of the hand are an unusual sign of lung cancer onset and may often be mistaken for other benign disorders, thus delaying diagnosis and treatment. PATIENT CONCERNS A 58-year-old man presented at the Rheumatology Clinic with a lump in the distal phalanx of the right index finger associated with intense pain, swelling, rib pain, and hemoptysis. DIAGNOSES Given the clinical manifestations, an x-ray of the right hand was performed, and it revealed an osteolytic lesion in the distal phalanx of the right index finger. The subsequent CT of the thorax and abdomen showed a lung tumor, osteolytic lesions in the ribs, sternum, and the thoracic spine. INTERVENTIONS Amputation of the phalanx was decided on account of intense pain refractory to NSAIDs and opioids. Pathology assessment established the diagnosis of bone metastases secondary to lung adenocarcinoma. The patient underwent 6 cycles of first-line palliative chemotherapy with cisplatin and gemcitabine with partial response according to the RECIST 1.1. criteria. EGFR and ALK testing were not available at the time. A year later, the patient presented with progressive disease, which lead to 6 more cycles of chemotherapy with docetaxel. The disease progressed during chemotherapy and the patient was switched to erlotinib. OUTCOMES After 7 months of anti-EGFR treatment, the patient passed away due to disease progression, thus having an overall survival of 25 months. LESSONS On rare occasions, acrometastases of the hand may be the first manifestation of a lung cancer and, as such, they must be taken into consideration in the differential diagnosis of rheumatologic disorders. They are a poor prognosis marker, but some cases like this one can have a better survival than reported in the literature, most likely due to that particular cancer's biology.
Collapse
Affiliation(s)
- Vlad-Adrian Afrăsânie
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | | | | | | | - Mihai Vasile Marinca
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | - Bogdan Gafton
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | | | - Marius-Ionut Păduraru
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | - Irina Demşa
- Cardiology Department, Emergency Hospital “Sf. Spiridon,” Iaşi, Romania
| | - Lucian Miron
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| | - Teodora Alexa-Stratulat
- “Gr.T. Popa” University of Medicine and Pharmacy
- Medical Oncology Department, Regional Institute of Oncology
| |
Collapse
|
|
16
|
Korsten P. Distal extremity metastases from prostate cancer in a patient with rheumatoid arthritis. Rheumatol Adv Pract 2019; 3:rkz040. [PMID: 31742244 PMCID: PMC6855276 DOI: 10.1093/rap/rkz040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Peter Korsten
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
|
17
|
Giordano V, Giordano M, Giordano C, Giordano J, Koch HA, Knackfuss IG. Metastatic tumor of the hand of unknown primary origin. SAGE Open Med Case Rep 2019; 7:2050313X19836894. [PMID: 30899514 PMCID: PMC6419255 DOI: 10.1177/2050313x19836894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/19/2019] [Indexed: 11/15/2022] Open
Abstract
Acral metastases in the hand are exceedingly rare. We present the unusual case of a metastatic tumor of the hand of unknown primary site in a 77-year-old man with no known cancer history. The patient presented with pain and swelling in the tip of the left ring finger, which had previously been diagnosed as gout at another clinic. Laboratory tests, including white blood cell count, erythrocyte sedimentation rate/C-reactive protein, and uric acid were all within normal limits. Excisional biopsy was taken by amputation of the distal phalanx of the left ring finger through the distal third of the middle phalanx. Pathology confirmed the presence of a moderately differentiated adenocarcinoma of unknown primary site. Roentgenographic examination of the chest revealed no pathologic findings. The patient refused further investigation and adequate treatment. He died 4 months later. The current description confirms the rarity of metastatic malignancy of the hand and its poor prognosis.
Collapse
Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Marcos Giordano
- Serviço de Traumato-Ortopedia, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil
| | | | | | - Hilton Augusto Koch
- Departamento de Radiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Irocy Guedes Knackfuss
- Departamento de Ortopedia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
|
18
|
Prognosis and treatment of acrometastases: Observational study of 35 cases treated in a single institution. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
|
19
|
Machado V, San-Julian M. Prognosis and treatment of acrometastases: Observational study of 35 cases treated in a single institution. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:49-55. [PMID: 30612612 DOI: 10.1016/j.recot.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE There is a degree of contradiction in the literature about the primary tumour that is most frequently associated with acrometastases, as well as their prognosis and treatment. The aim of this study is to determine the most frequent location of the acrometastases, the most frequent primary tumour according to its location, and to evaluate the surgical options according to the estimated survival. METHODS A retrospective study on patients diagnosed with acrometastases. The primary tumour, as well as the number, location, symptoms and treatment of the acrometastases and survival rate were collected. RESULTS 35 acrometastases in 21 patients were reviewed: 4 in the upper limbs and 31 in the lower limbs; the tibia was the most frequently affected bone (N=13). The primary tumour that most frequently produced acrometastases in the lower limb was hypernephroma (19%). In the upper limb lung tumour was more frequent (25%). Eleven patients died (52%); 10 of them had concomitant multiple metastases. The mean survival was 42 months from the diagnosis of acrometastases. CONCLUSION Acrometastases are more frequently seen in the lower extremities and the most frequent tumour was hypernephroma followed by lung. The treatment of acrometastases depends on the prognosis of the primary tumour, so a multidisciplinary approach is essential. The mean survival in our series did not imply a poorer prognosis for acrometastases, so it is feasible to consider surgical options such as wide resection and reconstruction. A unique acrometastases is a good prognosis signal.
Collapse
Affiliation(s)
- V Machado
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España.
| | - M San-Julian
- Departamento de Cirugía Ortopédica y Traumatología, Clínica Universidad de Navarra, Pamplona, España
| |
Collapse
|