Metastasis of squamous-cell carcinoma of the lung to the first web space of the hand

Acrometastases to the Hand: A Systematic Review

Background and Objectives: The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. Material and Methods: A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. Results: In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10–91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5–39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7–156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Conclusions: Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.

Acrometastases to the hand in stomach carcinoma: a rare entity

Acrometastasis caused by malignancy is a very rare phenomenon, and gastric malignancy metastasising to the hands is an even rarer entity. It accounts for only 0.1% of all metastatic osseous involvement, and may be a late manifestation of malignancy or may even be a presenting symptom. It is generally seen with lung primary, followed by kidney and breast, and less frequently with colon, liver, prostate, rectum and stomach primaries. The terminal phalanges are the most common sites of metastases, followed by the metacarpals and the proximal phalanges. We present a case of stomach carcinoma with metastases to the liver and adrenals which was managed with three lines of chemotherapy. He was lost to follow-up and reported after 1 year with swelling over his left hand, which was managed with palliative radiation to the hand in view of severe pain, followed by chemotherapy.

Metastases to the hand and wrist: an analysis of 221 cases

PURPOSE

To identify demographic trends, survival rates, the most common metastatic locations, and the most common primary malignant tumors in the reports of hand and wrist metastases published over the past 27 years.

METHODS

A keyword search was performed across PubMed, Google, Science Direct, and Springer databases with a time-range restriction set between April 1986 and April 2013. A total of 193 articles were located describing 221 patients. The data were analyzed for patient age, sex, known history of malignancy, primary tumor site, histological diagnosis, metastatic location, hand involvement, and survival rates.

RESULTS

Lung, gastrointestinal tract, and kidney malignancies were the 3 leading metastatic tumors. The mean age among patients was 61 ± 13 years, and involvement among men was almost twice as common as among women. The mean survival from the time of the diagnosis was 7 ± 7 months. There were no predilections for either the right or the left hand. The distal phalanx was the most frequently involved bone, and the thumb was the most frequently involved digit.

CONCLUSIONS

The frequency of published hand and wrist metastasis has increased dramatically within the last decade. Metastases have been reported for every bone of the hand and wrist as well as for the soft tissues. Compared with the previous studies, the mean age of reported patients has slightly increased even though the mean survival time has not changed.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Cancer lung: An unusual presentation

Phalanx bone metastasis as the initial manifestation of lung cancer is a rare presentation. A 70-year-old man presented with swelling and pain in his right ring finger. He had no other complaints or abnormal findings on clinical examination. A right hand radiograph showed an osteolytic lesion in the first phalanx of the ring finger. Fine needle aspiration cytology of the swelling suggested a metastatic adenocarcinoma. A skeletal survey, hematological, biochemical, and other radiological tests were found to be normal, except for an opacity seen in the right lung midzone. A bronchoscopic biopsy revealed adenocarcinoma of the lung.

Metastasis of bronchogenic carcinoma to the 5th metacarpal bone: a case report

Background

Metastatic lesions to the hand are very rare and represent 0.1% of all osseous metastases.

Case presentation

We present a patient with metastasis of bronchogenic carcinoma of the lung to the 5^th metacarpal to draw the attention for the potential of such lesions to be developed in this region. Due to the extensive metastasis to the hand the patient was referred to the oncologists.

Conclusion

The surgeon should be cautious regarding the differential diagnosis, the usual poor prognosis of such patients and the questionable need for reconstructive surgery.