Pathologic Tuft Fracture in a Thumb: A Rare Presentation of Metastatic Endometrioid Ovarian Carcinoma: A Case Report and Review of the Literature

[Treatment strategies for tumor-related pathological fractures of the extremities]

Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. The majority affect the femur, humerus and occasionally the tibia. Surgery is typically the first line treatment as healing under conservative treatment is unlikely. The most important goal is to relieve pain and the preservation or restoration of function. For correct assessment of indications, analysis of the fracture pattern and oncological aspects including dignity, entity, prognosis, metastatic status and the general condition of the patient need to be taken into consideration. Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.

Hand metastasis in a patient with cervical cancer: A case report

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.