Bilateral Acrometastasis Secondary to Breast Cancer

Multimodal Treatment of Metastatic Rectal Cancer in a Young Patient: Case Report and Literature Review

Metastatic colorectal cancer requires a multidisciplinary and individualized approach. Herein, we reported the case of a young woman diagnosed with metastatic rectal cancer who received an individualized multimodal treatment strategy that resulted in a remarkable survival. There were several particular aspects of this case, such as the early onset of the disease, the successful use of conversion therapy, the application of liquid biopsy to guide treatment, and the specific nature of the bone metastasis. To offer more insights for navigating such challenges in patients with metastatic colorectal cancer, we have conducted a literature review to find more data related to the particularities of this case. The incidence of early onset colorectal cancer is on the rise. Data suggests that it differs from older-onset colorectal cancer in terms of its pathological, epidemiological, anatomical, metabolic, and biological characteristics. Conversion therapy and surgical intervention provide an opportunity for cure and improve outcomes in metastatic colorectal cancer. It is important to approach each case individually, as every patient with limited liver disease should be considered as a candidate for secondary resection. Moreover, liquid biopsy has an important role in the individualized management of metastatic colorectal cancer patients, as it offers additional information for treatment decisions.

Current Overview of Treatment for Metastatic Bone Disease

The number of patients with bone metastasis increases as medical management and surgery improve the overall survival of patients with cancer. Bone metastasis can cause skeletal complications, including bone pain, pathological fractures, spinal cord or nerve root compression, and hypercalcemia. Before initiation of treatment for bone metastasis, it is important to exclude primary bone malignancy, which would require a completely different therapeutic approach. It is essential to select surgical methods considering the patient’s prognosis, quality of life, postoperative function, and risk of postoperative complications. Therefore, bone metastasis treatment requires a multidisciplinary team approach, including radiologists, oncologists, and orthopedic surgeons. Recently, many novel palliative treatment options have emerged for bone metastases, such as stereotactic body radiation therapy, radiopharmaceuticals, vertebroplasty, minimally invasive spine stabilization with percutaneous pedicle screws, acetabuloplasty, embolization, thermal ablation techniques, electrochemotherapy, and high-intensity focused ultrasound. These techniques are beneficial for patients who may not benefit from surgery or radiotherapy.

Atypical Unilateral Lower-Limb Relapse of Breast Cancer

ABSTRACT

In July 2017, an 84-year-old woman was treated for grade III, RH+, HER2- infiltrative ductal carcinoma breast cancer by right mastectomy, adjuvant radiotherapy, and hormone therapy. In April 2020, moderated elevation of the CA-15.3 tumor marker was observed at 53 UI/mL (normal, <25.5 UI/mL). Clinical examination and CT TAP scan showed no argument for relapse. In August 2020, patient presented pain in her left foot. 99mTc-DPD bone scintigraphy showed multiple uptakes regarding osteolytic lesion of the left lower limb with no other pathological uptake. Echo-guided tibial biopsies confirmed breast origin adenocarcinoma, in favor of relapse of the originally treated cancer.

Case Report of a Posterior Malleolus Metastasis: A Very Rare Metastasis Localization

Metastasis of the distal tibia is quite rare. In this article, we present the case of a 58-year-old woman with distal tibial metastasis located in the posterior malleous caused by breast cancer. She had left ankle pain and nonweightbearing status that had been ongoing for 2 months and showed progression. The patient's Mirels score was 10. Limb salvage surgery was performed by removing the metastatic lesion by posterior ankle incision followed by applying a double plate from the posterior and the medial side of the distal tibia, and the defect was reconstructed with methylmethacrylate. Consequently, good stability was achieved. Radiotherapy consisting of 10 fractions (2000 cGy total) was applied to the distal tibia at postoperative week 3. There were no complications after surgery. No recurrence was observed at the 18-month follow-up of the patient. The Musculoskeletal Tumor Society Score at the 18-month control of the patient was 86%. Use of curettage of the metastatic mass, double-plate application, and defect reconstruction with methylmethacrylate is an effective method for distal tibia metastases located in the posterior malleolus.

Foot metastasis: Current knowledge

Foot metastasis are rare and often overlooked due to non-specifical symptoms. This often leads to misdiagnosis delaying the right diagnosis. Metastatic disease of the foot is rare. Foot pain and swelling may be the presenting symptom of an occult malignancy. If metastatic disease is not kept in the differential diagnosis of foot pain, diagnosis and treatment will be delayed. The purpose of this study was to analyze articles presenting cases of foot metastasis to provide a more accurate incidence of symptomatic foot acrometastasis as well as to review the clinical course and outcomes. Studies were searched on PubMed/Medline from the inception to February 2020. All studies included in the review presented foot metastasis either with or without a known primary tumor. Most of the articles were case reports, to which we added two case reports of foot acrometastasis produced by our Institute. Forty-three studies with a total of 45 patients were included in this review. The literature published mostly concerning case reports about old patients (average age: 63,2), in a late phase of their disease. Lung cancer appeared to be the most common primary tumor, followed by endometrial and breast cancer. In the 36% of the cases foot metastasis were found when the primary site was still unknown. Calcaneus and metatarsal bones were the most common bones involved. Surgical solution is rare, the chosen treatments are often of palliative care. Prognosis was often poor, death occurred within 2 years since the discovery of foot metastasis in about 50% of cases.

Isolated Calcaneal Metastasis: An Unusual Presentation of Lung Carcinoma as Heel Pain

A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma. Tc-MDP total-body bone scintigraphy was ordered for possible other bony lesions, and only left calcaneus lesion was identified on bone scan. CT scan of the chest revealed a soft tissue mass in the superior aspect of the right lower lobe. Staging FDG PET/CT showed hypermetabolic right lung mass and left calcaneus lesion. She received chemotherapy and local radiation to the left calcaneus metastatic lesion.

A finding with a diagnosis: I just can't put my finger on it

A 72-year-old man with metastatic squamous cell carcinoma of the lung presents with new lesions in the distal phalanx of right fifth finger (painful) and left great toe (painless due to long-standing peripheral neuropathy). Initially a complication of cytotoxic chemotherapy is considered and a dermatological opinion is requested. Enlargement of the lesions over the space of a week leads to plain X-ray, with findings of destruction of the distal phalanx of the involved digits confirming metastatic disease. Palliative radiotherapy is administered to decrease pain and reduce the likelihood of cutaneous and infectious complications. The patient died from systemic disease progression soon after finishing his radiotherapy. Digital metastasis (acrometastasis) should be considered by clinicians in the workup of patients with persistent digital symptoms, particularly in those with known cancer or those at high risk of cancer.

Bilateral acrometastasis in a case renal cell carcinoma

We present a unique case of bilateral skeletal metastasis below the knee in a patient with renal cell carcinoma. In this rarest of rare cases, bony metastases were the first presentation of a primary tumour. Incidentally, the primary tumour (renal cell carcinoma) involved the solitary kidney of the patient and the same patient also had coexisting carcinoma of the prostate.

Multifocal bilateral metatarsal tuberculosis: a rare presentation

Tuberculosis, or phthisis (consumption) as it was popularly known in the Greek era, has been endemic in Southeast Asia and Sub-Saharan Africa; however, the human immunodeficiency virus epidemic has seen the re-emergence of this disease in the areas in which it was not very commonly reported. With this, the need for understanding and treatment of rare presentations of tuberculosis has become of paramount importance to achieve the World Health Organization millennium goal of a "reversal of incidence by 2015." Foot involvement has been reported in 0.1% to 0.3% of extrapulmonary cases. Multifocal lesions have an incidence of <10% in osteoarticular tuberculosis. Bilateral feet involvement in multifocal tuberculosis has not yet been reported in either children or adults in published studies. We report a case of tuberculosis with lesions in the bilateral metatarsals, the occurrence of which is very rare. The diagnosis was mainly histopathologic owing to the paucibacillary nature of the disease. Early identification and treatment with antitubercular drugs will normally result in a good cosmetic and functional result.

The chiropractic care of patients with cancer: a systematic review of the literature

BACKGROUND AND SIGNIFICANCE

Cancer is the leading cause of death worldwide and accounted for 7.4 million deaths in 2004. By 2030, deaths from cancer have been estimated at 12 million with 30% being preventable. Complementary and alternative medicine remains popular among cancer patients; particularly with chiropractic services. However, the nature of the chiropractic clinical encounter and its reported benefits remains to be fully investigated. Towards these efforts, we begin with a systematic review of the literature on the chiropractic care of patients with cancer.

METHODS

The following electronic databases were searched: MANTIS [1965-2010]; Index to Chiropractic Literature [1984-2010]; Pubmed [1966-2010]; Medline [1965-2010] EMBASE [1974-2010], AMED [1975-2010], CINAHL Plus [1965-2010], Alt-Health Watch [1965-2010] and PsychINFO [1965-2010]. Key words used were "cancer" and "neoplasm" in Boolean combination with "chiropractic." Primary investigation/reports in peer-reviewed English journals involving chiropractic care were reviewed.

RESULTS

Our review revealed 60 case reports, 2 case series, 21 commentaries, 2 survey studies, and 2 literature reviews. The case reports were diagnostic with commentaries highlighting the importance of recognizing the patient presenting with NMS complaints due to an underlying neoplasm. The chiropractic clinical encounter prior to cancer diagnosis and subsequent medical referral is poorly characterized in the literature.

CONCLUSION

Patients with cancer seek the care of chiropractors. The literature does not reflect or describe the totality of the chiropractic clinical encounter. We encourage further research in this field.