Acrometastasis: First Metatarsophalangeal Joint Pain Due to Metastatic Lung Cancer: A Case Report

Bone metastases of the hand

Introduction The aim of this study was to identify patients with malignant hand lesions, establish the proportions of those that were metastases and review their clinical course. Methods A retrospective search of a prospective tumour database was carried out to identify all patients treated at our unit with hand metastases. Patient demographics were recorded including site of primary malignancy, region of the hand involved, management of their metastasis and clinical outcome. Results Overall, 149 patients were identified with a malignant tumour of the hand. Ten had a metastatic lesion. There were 3 women and 7 men with a median age of 68 years (range: 28-91 years) at presentation. All presented with non-mechanical hand pain while four had pain and swelling. The median interval from symptom onset to diagnosis was eight weeks. The minimum follow-up duration was four months. Three patients had no history of malignancy. Of the remaining seven patients, three had other known metastases. Six patients underwent solely palliative radiotherapy. Three patients had amputation. One was treated with surgical excision and radiotherapy. One had an amputation and axillary node clearance. All but one patient had died by the time of the latest follow-up appointment. The median time to death following identification of acrometastases was 18 months. Sites of primary disease were skin (n=4), lung (n=3), kidney (n=2) and neuroendocrine system (n=1). The thumb was the most commonly affected location. Conclusions This study demonstrates that patients presenting with non-mechanical hand pain should be considered to have a malignant process until proved otherwise, particularly in patients with thumb symptoms and a history of prior malignancy.

Delayed diagnosis in metastatic lesions of the foot

INTRODUCTION

Pedal acrometastases are a rare complication of disseminated malignancy. To date, there is little in the literature documenting their clinical course.

METHODS

Our large orthopaedic oncology database was used to review the clinical course of symptomatic pedal acrometastases.

RESULTS

A total of 15 cases of pedal acrometastases were identified from 2,595 patients with metastases. The median age at presentation was 64.5 years (range: 14-83 years) and the median length of foot symptoms (predominantly pain and swelling) prior to diagnosis of metastasis was 16 weeks (range: 6-104 weeks). The median survival following diagnosis was 4.6 months (range: 2.3-104.5 months).

CONCLUSIONS

This study suggests that 0.58% of all osseous metastases involve the foot, and that symptoms of foot pain and swelling are often misdiagnosed, leading to delays in treatment. A high index of suspicion is required to diagnose pedal acrometastases early, thereby allowing early treatment so that the patient's quality of life can be maintained prior to death.