1
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Curtis KL, Lipner SR. Metastases to the nail unit and distal phalanx: a systematic review. Arch Dermatol Res 2023; 315:347-358. [PMID: 36260150 DOI: 10.1007/s00403-022-02411-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/02/2022]
Abstract
Metastases to the nail unit/distal phalanx (NU/DP), although rare, carry a poor prognosis and are frequently misdiagnosed due to variable clinical presentation. Metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy. Since the most recent systematic review of case reports (133 patients total) was conducted in 2001, we conducted a systematic review from 1900 to 2021 (244 patients total) to assess any changes in trends in demographics, clinical presentation, and morphology and to report on more updated differential diagnoses. We also examined cases for age, sex, race, ethnicity, Fitzpatrick skin type, laterality, distribution, and diagnostic methods. The PubMed database (1900-2021) was used to detect case-level data per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We found that the most common primary tumors were lung, kidney, and esophagus. A NU/DP metastasis was the presenting sign of malignancy in 31.00% of patients without a former cancer diagnosis. Male to female ratio was 2:1, with average age at diagnosis 58 years. Metastases most often affected a single digit (79.91%), particularly the thumb, followed by the fourth digit. This systematic review corroborates that metastases to the NU/DP may be the initial presenting sign of a new or recurrent malignancy and provides updated diagnostic guidelines. NU/DP metastasis should be considered in both healthy patients and patients with a former malignancy diagnosis presenting with nail changes involving a single digit. Prompt diagnosis and treatment may improve prognosis.
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Affiliation(s)
- Kaya L Curtis
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10021, USA
| | - Shari R Lipner
- Weill Cornell Dermatology, 1305 York Avenue, New York, NY, 10021, USA.
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2
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Wu H, Han R, Zhang Q, Zhao Y, Feng H. Metatarsal metastasis from clear cell renal cell carcinoma: a case report and literature review. BMC Urol 2020; 20:19. [PMID: 32093684 PMCID: PMC7041269 DOI: 10.1186/s12894-020-00588-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background Bone metastasis is known to occur in some patients with cancer, usually in the spine, pelvis or ribs, and less than 0.01% of patients have metastases in the foot bone, so metatarsal metastasis is quite rare. The initial symptoms of osseous metastases are swelling, pain, or both. Case presentation We report a 68-year-old man with solitary metatarsal metastasis 26 months after a diagnosis of renal clear cell carcinoma. The patient suffered intermittent swelling of his right foot and pain for one year due to trauma and was not treated. The doctor attributed the symptoms to trauma, administering massage therapy and a plaster cast to the patient at the local clinic. After reviewing the medical records, we found that this patient had a history of clear cell renal cell carcinoma. The patient underwent radiological examination and open biopsy of the first metatarsal bone of the right foot. These findings confirmed that the patient had a metatarsal metastasis from clear cell renal cell carcinoma. The patient subsequently underwent right foot amputation. No local recurrence or distant metastasis was found after a 6-month follow-up. Conclusion Clinicians should be aware of a history of renal cell carcinoma (RCC) and fully understand the patient’s past medical history. When treating patients with clear cell renal cell carcinoma who have unresolving bony pain or swelling, clinicians should always keep in mind the possibility of bone metastasis of RCC.
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Affiliation(s)
- Hongzeng Wu
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Ruoqi Han
- Department of Breast Surgery, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Qianqian Zhang
- Department of Gynecology, Hebei Medical University Second Affiliated Hospital, 215 Heping Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Yi Zhao
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China
| | - Helin Feng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, 12 Health Road, Shijiazhuang, Hebei, 050011, People's Republic of China.
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3
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Ravind R, Prameela CG, Gurram BC, Dinesh M. Synchronous phalangeal metastases in upper and lower limbs from primary breast malignancy: a rare case scenario with a review of the literature. BMJ Case Rep 2015; 2015:bcr-2015-213246. [PMID: 26698209 DOI: 10.1136/bcr-2015-213246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Osseous metastasis from a primary breast cancer is common, and the skeletal related morbidity is high. However, solitary acral bony metastasis is rare and the diagnosis of these lesions poses a challenge to the physician. We describe a case of a patient treated with primary breast cancer who later presented with metastatic osteolytic bone lesions confined to a forefinger and toe.
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Affiliation(s)
- Rahul Ravind
- Department of Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Chelakkot G Prameela
- Department of Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Bharath Chandra Gurram
- Department of Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Makuny Dinesh
- Department of Radiation Oncology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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4
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Trinidad J, Kaplansky D, Nerone V, Springer K. Metastatic adenosquamous carcinoma of the foot: a case report. J Foot Ankle Surg 2012; 51:345-51. [PMID: 22321441 DOI: 10.1053/j.jfas.2012.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Indexed: 02/03/2023]
Abstract
Metastasis of carcinoma to the bones of the foot is rare and carries with it a very poor prognosis for patients. Acrometastasis can be the initial manifestation of an occult cancer or widespread metastasis of a previously diagnosed cancer. A high level of suspicion and timely diagnosis are essential to the timely diagnosis and treatment of this condition. In this report, a case of metastatic non-small cell lung carcinoma to the first metatarsal, intially diagnosed as acute gout, is presented.
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Affiliation(s)
- Jennifer Trinidad
- Department of Orthopedics, The Ohio State University, Columbus, OH, USA
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5
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Brownlow HC, Ioannidis G, Gibbons MC, Jones AC, Athanasou N. Digital metastases of giant cell rich malignant fibrous histiocytoma. Sarcoma 2011; 3:167-70. [PMID: 18521280 PMCID: PMC2395425 DOI: 10.1080/13577149977596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background. Metastatic spread of soft tissue sarcomas to the digits is extremely rare and metastasis of MFH to the fingers and toes has not been documented.Purpose. We present two case reports of metastatic spread from a giant cell rich malignant fibrous histiocytoma to the digits and discuss their management.
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Affiliation(s)
- H C Brownlow
- Nuffield Department of Orthopaedic Surgery Nuffield Orthopaedic Centre Headington Oxford OX3 7LD UK
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6
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El Ghazaly SA, DeGroot H. Metastases to bones of the foot: a case series, review of the literature, and a systematic approach to diagnosis. Foot Ankle Spec 2008; 1:338-43. [PMID: 19825737 DOI: 10.1177/1938640008326384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Metastatic lesions to the bones of the foot are rare but pose a challenge to the treating surgeon because of variation in presentation. Cases may present as a painful or swollen toe or as an infection resistant to antibiotics, or they may mimic inflammatory arthropathy. As such, diagnosis may be delayed. Also, with the advent of new therapies for certain cancers, patients living longer have time to develop metastases. The incidence of metastases to the foot is changing. The senior author (HD) has managed 3 consecutive cases of tumorous lesions metastasizing to the foot. Patients included 1 man and 2 women, with an average age of 76.7 years (range, 57-88 years). Open biopsy was performed in 2 cases, whereas true-cut needle biopsy was performed in 1 case. The average follow-up was 16.2 months (range, 8.5-29 years). The pattern and incidence of foot metastases may be changing. Early and accurate diagnosis may help improve patient survival. A working protocol is presented here that can help in diagnosing such lesions.
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7
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Maheshwari AV, Chiappetta G, Kugler CD, Pitcher JD, Temple HT. Metastatic skeletal disease of the foot: case reports and literature review. Foot Ankle Int 2008; 29:699-710. [PMID: 18785420 DOI: 10.3113/fai.2008.0699] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Metastatic disease of the skeleton occurs in at least 20% to 30% of patients with malignancy, but metastasis to the foot and hand (acrometastasis) is extremely rare (0.007% to 0.3%). Metastases to the feet are even rarer and have been reported in half to one-third the rate for hand metastases. Failure to recognize these lesions has led to delayed diagnosis and/or inappropriate treatment. The purpose of this report is to highlight the clinical and radiologic features that aid in the diagnosis and potential treatment of this condition along with a pertinent review of the literature. MATERIALS AND METHODS In a retrospective review of 694 patients with histologically proven metastatic skeletal disease (January 1988 to January 2007), 14 cases of metastatic lesions to the foot were identified. RESULTS The most frequent primary site was in the genito-urinary system in eight patients and the most common bones involved were the calcaneus and the talus in six patients each. All patients died after a mean survival of 14.8 (range, 1 to 54) months after diagnosis of metastases. CONCLUSION Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot, especially if suspicious radiographic changes are present in an older patient. The common primary sites are the genito-urinary, lungs, breast, and the colo-rectum. Treatment is usually palliative to reduce pain and maintain function.
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Affiliation(s)
- Aditya V Maheshwari
- Cedars Medical Center, Suite 4036, 4th floor, East building, 1400 NW 12th Ave, Miami, FL 33136, USA.
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8
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García-Arpa M, Rodríguez-Vázquez M, Sánchez-Caminero P, Delgado M, Vera E, Romero G, Cortina P. Metástasis digital acral. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:334-6. [PMID: 16956567 DOI: 10.1016/s0001-7310(06)73413-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Cutaneous metastases are infrequent and in some cases represent the first manifestation of an unknown neoplasm. Acrally located metastases are particularly rare, and the prognosis is very poor, with a survival time of only a few months. Although the clinical presentation varies, they are generally confused with an infectious or inflammatory process, which delays diagnosis. When they are located on the fingers, the most frequent cause is lung carcinoma, while those located on the toes are usually due to tumors in the genitourinary tract. The histology of the metastasis is similar to that of the primary tumor, although less differentiated. In most acrometastases, first the bone and then the skin are affected. Treatment is palliative. We present the case of a patient with a metastasis on the big toe as an initial sign of a previously unknown lung tumor.
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9
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Kaplansky DB, Kademian ME, VanCourt RB. Metastatic squamous cell carcinoma resembling cellulitis and osteomyelitis of the fifth toe. J Foot Ankle Surg 2006; 45:182-4. [PMID: 16651199 DOI: 10.1053/j.jfas.2006.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Statistically, metastasis of carcinomas to pedal phalanges is rare. However, true to all bone metastases of the body, its presence is associated with a very poor prognosis. A case of metastatic sinonasal squamous cell carcinoma to the fifth toe is presented followed by a review of the literature.
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Affiliation(s)
- David B Kaplansky
- Section of Podiatry, The Ohio State University Medical Center, Columbus, OH, USA
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10
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Zeytoonjian T, Mankin HJ, Gebhardt MC, Hornicek FJ. Distal lower extremity sarcomas: frequency of occurrence and patient survival rate. Foot Ankle Int 2004; 25:325-30. [PMID: 15134614 DOI: 10.1177/107110070402500509] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary sarcomas in the distal leg, tibia, fibula, ankle, and foot are uncommon and are believed to be less malignant than those that arise in other sites, but only limited information is available to support this contention. METHODS Using a computerized system containing extensive information regarding over 14,000 patients, mostly with tumors treated by our center over a 25-year period, 175 sarcomatous lesions with MSTS stage I, II, and III were located in the distal lower extremity. These were compared with 2367 lesions of similar diagnoses in other body parts. The principal studies included diagnostic distribution and outcome (recorded as death as a result of disease). Data were compared for diagnosis, gender, age, Musculoskeletal Tumor Society (MSTS) stage, anatomic site, and treatment methods and evaluated statistically by chi-square methods. RESULTS The most frequent distal lower limb tumors were synovial cell sarcoma, osteosarcoma, and Ewing's tumor and the percentage distribution of the various tumors for that site as compared with the rest of the body was quite different. Of even more importance was the remarkable difference in outcome with the death rate for the lower limb tumors set at 10%, while the same tumors at other sites had a death rate of 27% (p <.000002). Furthermore, gender, stage, age, and the type of operative procedure showed highly significant differences between the tumors of the lower leg and those of the remainder of the body. CONCLUSIONS On the basis of these data, it is evident that far fewer sarcomas occur in the lower leg, tibia, fibula, ankle, and foot than in other body sites and that their diagnostic distribution is different. Of perhaps greater interest is the fact that the rate of metastasis and death is markedly reduced for this site as compared with others. The authors speculate on the causes of this remarkable alteration in numbers and outcome.
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Affiliation(s)
- Trisha Zeytoonjian
- Orthopaedic Oncology Service, Massachusetts General Hospital, Boston 02114, USA
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11
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Jänne PA, Datta MW, Johnson BE. Lung cancer presenting with solitary bone metastases. Case 2: acrometastasis as an initial presentation of non-small-cell lung carcinoma. J Clin Oncol 1999; 17:2998-3001. [PMID: 10561378 DOI: 10.1200/jco.1999.17.9.2998] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- P A Jänne
- Lowe Center for Thoracic Oncology, Department of Adult Oncology, Dana Farber Cancer Institute, and Departments of Pathology and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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12
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Shepherd DM, Dzikowski CM, Chussid F. Bronchogenic carcinoma mimicking paronychia and osteomyelitis in the great toe. J Foot Ankle Surg 1997; 36:115-9. [PMID: 9127214 DOI: 10.1016/s1067-2516(97)80056-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Bone metastases from malignant tumors are common, but metastatic lesions to the bones of the foot are very rare. The most common primary lesion is the genitourinary tract, and the tarsal bones are most commonly involved. We present a rare case of squamous cell carcinoma of the lung, metastatic to the right great toe, that presented clinically as paronychia and osteomyelitis. This was the primary manifestation of an occult and disseminated disease.
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Affiliation(s)
- D M Shepherd
- Department of Podiatry, Florida Medical Center South, Plantation, USA
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