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Ferini G, Zagardo V, Viola A, Aiello MM, Harikar MM, Venkataram T, Palmisciano P, Illari SI, Valenti V, Umana GE. Considerations on surgery invasiveness and response and toxicity patterns in classic palliative radiotherapy for acrometastases of the hand: a hint for a potential role of stereotactic body radiation therapy? A case report and literature review. Front Oncol 2023; 13:1146041. [PMID: 37441424 PMCID: PMC10335800 DOI: 10.3389/fonc.2023.1146041] [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] [Received: 01/16/2023] [Accepted: 05/25/2023] [Indexed: 07/15/2023] Open
Abstract
Background The rarity of hand acrometastases hampers the consensus-building for their optimal management among the involved oncology professionals. In the current literature, demolitive surgery overcomes the use of palliative radiotherapy, which proved to be ineffective in more than 30% of cases treated with classic palliative dose schemes, carrying also a not negligible radiation-related adverse event rate. Against this background, stereotactic body radiation therapy (SBRT) could emerge as a well-balanced therapeutic option. Case summary Here we describe the methods and outcomes of a SBRT treatment of a painful and function-limiting hand acrometastasis in a patient with a history of stage IIIB lung adenocarcinoma. We delivered a total dose of 30 Gy in five daily fractions to a soft-tissue metastasis abutting the fifth metacarpal bone through the SBRT protocol generally used for intracranial treatments. A few weeks later, the patient reported a clinical complete response with acrometastasis and pain disappearance, function recovery, and no significant toxicity. The acrometastasis was the first sign of an atypical cancer progression. Conclusions SBRT for hand acrometastases is feasible and might have the best therapeutic profile among the currently available treatment options for this rare clinical scenario. Larger investigations are needed to confirm the present single-case experience.
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Affiliation(s)
- Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
| | - Valentina Zagardo
- Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
| | - Anna Viola
- Department of Radiation Oncology, Fondazione Istituto Oncologico del Mediterraneo (IOM), Viagrande, Italy
| | - Marco Maria Aiello
- Medical Oncology, University Hospital Policlinico San Marco, Catania, Italy
| | | | - Tejas Venkataram
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Salvatore Ivan Illari
- Department of Radiation Oncology, Fondazione Istituto Oncologico del Mediterraneo (IOM), Viagrande, Italy
| | - Vito Valenti
- Department of Radiation Oncology, REM Radioterapia Srl, Viagrande, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
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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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Acrometastases to the Hand: A Systematic Review. MEDICINA-LITHUANIA 2021; 57:medicina57090950. [PMID: 34577873 PMCID: PMC8471162 DOI: 10.3390/medicina57090950] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
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.
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Tsukamoto S, Kido A, Tanaka Y, Facchini G, Peta G, Rossi G, Mavrogenis AF. Current Overview of Treatment for Metastatic Bone Disease. Curr Oncol 2021; 28:3347-3372. [PMID: 34590591 PMCID: PMC8482272 DOI: 10.3390/curroncol28050290] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/26/2021] [Indexed: 12/16/2022] Open
Abstract
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.
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Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
- Correspondence: ; Tel.: +81-744-22-3051
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
| | - Giancarlo Facchini
- Department of Radiology and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.F.); (G.P.); (G.R.)
| | - Giuliano Peta
- Department of Radiology and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.F.); (G.P.); (G.R.)
| | - Giuseppe Rossi
- Department of Radiology and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (G.F.); (G.P.); (G.R.)
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562 Athens, Greece;
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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: 1.0] [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.
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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
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6
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Digital metastasis prior to lung adenocarcinoma diagnosis in a geriatric patient. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lambe G, Le P, Clay TD. A finding with a diagnosis: I just can't put my finger on it. BMJ Case Rep 2014; 2014:bcr-2014-208665. [PMID: 25535240 DOI: 10.1136/bcr-2014-208665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Gerard Lambe
- Department of General Medicine, Rockingham General Hospital, Rockingham, Western Australia, Australia
| | - Patricia Le
- Department of Dermatology, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia
| | - Timothy D Clay
- Department of General Medicine, Rockingham General Hospital, Rockingham, Western Australia, Australia Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Metastasis of hepatocellular and renal cell carcinoma to the hand. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 1:e83. [PMID: 25289277 PMCID: PMC4174103 DOI: 10.1097/gox.0000000000000021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/03/2013] [Indexed: 11/25/2022]
Abstract
Summary: Malignant carcinoma metastasis to the skeleton is the third most common site of metastasis after lung and liver, usually involving the axial skeleton and the proximal ends of long bones, ribs, and vertebrae. Acrometastasis, metastasis to hands or feet, comprises only 0.1% of all metastases. Here, we present 2 cases of acrometastasis, one from hepatocellular carcinoma and the other from renal cell carcinoma. We describe the presentation, radiographs, surgical treatment, and outcomes for each patient. Patients presented with swelling and pain at the tumor sites and were treated with amputations. The second patient’s disease progressed resulting in death shortly after amputation indicating acrometastasis may be a poor prognostic indicator of survival. We review the literature and discuss the importance of disease process recognition and prognosis.
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Afshar A, Farhadnia P, Khalkhali H. Metastases to the hand and wrist: an analysis of 221 cases. J Hand Surg Am 2014; 39:923-32.e17. [PMID: 24612837 DOI: 10.1016/j.jhsa.2014.01.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 02/02/2023]
Abstract
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.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
| | - Payam Farhadnia
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Hamidreza Khalkhali
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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10
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Mavrogenis AF, Mimidis G, Kokkalis ZT, Karampi ES, Karampela I, Papagelopoulos PJ, Armaganidis A. Acrometastases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:279-83. [DOI: 10.1007/s00590-013-1311-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/28/2013] [Indexed: 01/06/2023]
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Acrometastasis and the potential benefits of early positron emission tomography scanning. Ann Plast Surg 2012; 67:189-92. [PMID: 21508822 DOI: 10.1097/sap.0b013e3181f3e36e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case report of a rare proximal phalanx metastasis from a primary lung carcinoma is described. The presenting symptom of the patient was pain in the proximal phalanx of the index finger. Radiographs at the time of presentation were unremarkable, and no diagnosis was provided. Because of increasing pain and eventual swelling, the patient presented for emergency assessment. Radiographs, less than 3 months after initial assessment, demonstrated a large lytic lesion within the proximal phalanx. Biopsy of the lesion documented a large cell malignancy consistent with a poorly differentiated adenocarcinoma. Subsequent investigations documented an occult lung neoplasm. The patient underwent palliative ray resection followed by the initiation of palliative chemotherapy for the primary carcinoma. A brief review of literature regarding acrometastases is provided and the potential benefit of early positron emission tomography scanning is discussed.
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Amar M, Almoubaker S, Lahrach K, Chbani B, Bennani A, Marzouki A, Boutayeb. F. Tumeur géante du pouce révélant un adénocarcinome pulmonaire (à propos d’un cas). ACTA ACUST UNITED AC 2011; 30:133-5. [DOI: 10.1016/j.main.2011.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 12/22/2010] [Accepted: 01/10/2011] [Indexed: 12/25/2022]
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An atypical extrahepatic metastasis of the distal phalanx from hepatocellular carcinoma. Int J Clin Oncol 2009; 14:159-62. [DOI: 10.1007/s10147-008-0806-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 06/11/2008] [Indexed: 12/15/2022]
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Spiteri V, Bibra A, Ashwood N, Cobb J. Managing acrometastases treatment strategy with a case illustration. Ann R Coll Surg Engl 2009; 90:W8-11. [PMID: 18831862 DOI: 10.1308/147870808x303137] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The hand is the site of a great variety of benign lesions and, rarely, of malignant lesions. Acrometastasis can be the first manifestation of occult malignancy. Frequently, these lesions present in a similar way to benign conditions leading to erroneous diagnosis and inappropriate treatment. When located in the finger, the most frequent cause is lung cancer, while in the toes it is due to genito-urinary tumours. Awareness of the possibility of metastatic disease during orthopaedic assessment is essential to decrease patient morbidity. A case that was referred to our institution with a single metastasis in a digit from occult gastric adenocarcinoma is used to illustrate the way these lesions are managed. The diagnostic difficulties are summarised and an overview of literature was performed to determine management pathways to aid others in the treatment of these case.
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Affiliation(s)
- V Spiteri
- Department of Orthopaedics, Middlesex Hospital, London, UK
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Bahar T, Borman H, Ertas NM, Seyhan T. Three years' survival after diagnosis of finger metastasis from end-stage lung cancer. Dermatol Surg 2008; 34:1128-30. [PMID: 18462410 DOI: 10.1111/j.1524-4725.2008.34226.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Taner Bahar
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Baskent University, Ankara, Turkey.
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16
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Akjouj S, El Kettani N, Semlali S, Chaguar B, Chaouir S, Hanine A, Benameur M. Acrométastase du pouce révélant un adénocarcinome pulmonaire : à propos d'un cas avec revue de la littérature. ACTA ACUST UNITED AC 2006; 25:106-8. [PMID: 16841775 DOI: 10.1016/j.main.2006.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bone metastases in the hand and foot bone (acrometastases) are rarely observed. The authors report a case of a 57-years-old man diagnosed as hand tumour, revealing a bronchic adenocarcinoma. Radiography showed destruction of the phalanx, and histology study confirmed a metastasis of the lung cancer.
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Affiliation(s)
- S Akjouj
- Service d'imagerie médicale, hôpital militaire d'instruction Mohamed-V, Rabat, Maroc
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