1
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Sakai T, Fujii M, Mawatari M. Total talar replacement for metastatic pulmonary adenocarcinoma of the talus: A case report. Clin Case Rep 2024; 12:e9049. [PMID: 38910834 PMCID: PMC11192581 DOI: 10.1002/ccr3.9049] [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: 02/06/2024] [Revised: 04/27/2024] [Accepted: 05/25/2024] [Indexed: 06/25/2024] Open
Abstract
Talar metastases from malignant tumors are rare and poorly documented. Treatment requires gradual relief of pain and preservation of function, with a choice between palliative measures and surgery. This case indicates that total talar replacement is an effective intervention for localized talar metastases and highlights the importance of early intervention. A 48-year-old man was diagnosed with a pathologic talar fracture due to talar metastases was observed after 8 years of chemotherapy following a diagnosis of lung adenocarcinoma. Despite radiotherapy, the patient's activities of daily living (ADLs) deteriorated due to pain on walking, prompting a request for surgical intervention. Total talar replacement was performed, allowing the patient to begin full weight-bearing ambulation 2 weeks post-operatively. Total talar replacement appears to be an effective treatment for localized talar metastases and should be performed as early as possible.
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Affiliation(s)
- Tatsuya Sakai
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of MedicineSaga UniversitySagaJapan
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2
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Coe C, Chirputkar K, Joseph L, Jude EB. Pedal acrometastasis secondary to urothelial carcinoma masquerading as Charcot arthropathy in a patient with diabetes. BMJ Case Rep 2023; 16:e254468. [PMID: 37730428 PMCID: PMC10514597 DOI: 10.1136/bcr-2022-254468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
A woman in her 80s with known diabetes mellitus and bladder cancer presented to her general practitioner (GP) with pain and swelling in her left foot following trauma. Initial radiographs were reported as normal, prompting a diagnosis of a simple sprain and conservative management. Three months later, the patient was referred to the orthopaedic team due to progressively increasing pain and swelling. Repeat X-rays revealed lytic lesions in both the talus and navicular bones; MRI confirmed the presence of a lytic and proliferative defect in the mid-foot, which was reported as acute Charcot arthropathy with superimposed infection. This was also considered the most likely diagnosis when imaging was reviewed in two separate multidisciplinary team) meetings. However, biopsy demonstrated that the cause of the presentation was in fact acrometastasis from urothelial carcinoma, an infrequently described entity.
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Affiliation(s)
- Calvin Coe
- Endocrinology and Diabetes, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Kedar Chirputkar
- Trauma and Orthopaedic Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Leena Joseph
- Histopathology, Manchester University NHS Foundation Trust, Manchester, UK
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3
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Khan I, Peters J, Welck M, Saifuddin A. Sinus tarsi and sinus tarsi syndrome: An imaging review. Eur J Radiol 2023; 161:110725. [PMID: 36773427 DOI: 10.1016/j.ejrad.2023.110725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/14/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
The sinus tarsi is a funnel-shaped region at the junction of mid-foot and hind-foot which contains fat, vessels, nerves and ligaments. The ligaments help stabilise the subtalar joint and maintain the longitudinal arch of the foot. The nerve endings contain proprioceptive fibres indicating a role for the sinus tarsi in movement of the foot. Sinus tarsi syndrome is a clinical entity characterised by lateral hind-foot pain with worsening on palpation and weight-bearing, and perceived instability. It is associated with both traumatic and non-traumatic causes. Magnetic resonance imaging is the imaging modality of choice for assessment of the sinus tarsi and sinus tarsi syndrome. In this review article, we review the anatomy and various aetiologies of sinus tarsi syndrome, along with the imaging appearances.
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Affiliation(s)
- Imran Khan
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester LE5 4PW, United Kingdom.
| | - Jonathan Peters
- Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Matt Welck
- Foot and Ankle Reconstruction Unit, Royal National Orthopaedic Hopsital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
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4
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Primary digital localization of extra-axial extra-osseous soft-tissue chordoma: A case report. HAND SURGERY & REHABILITATION 2021; 40:804-807. [PMID: 34375728 DOI: 10.1016/j.hansur.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
We report a case of digital extra-axial extra-osseous soft-tissue chordoma located in a flexor synovial sheath of the little finger of the left hand. Histology-immunohistochemistry (brachyury) analysis after broad en-bloc resection confirmed the diagnosis. Exhaustive MRI assessment of the entire spine, skull and pelvis found no other locations. No recurrence was reported at last follow-up. Hand surgeons should be aware of the diagnosis and treatment of brachyury-positive extra-axial soft-tissue chordomas, whence the importance of recognizing its typical and differential characteristics to guide optimal therapeutic strategy.
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5
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Kanjiya S, Nazemi A, Paulus M. Talar Osteolytic Lesion as the Initial Presentation of Terminal Primary Metastatic Adenocarcinoma: A Case Report. J Foot Ankle Surg 2021; 60:152-156. [PMID: 33189542 DOI: 10.1053/j.jfas.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this case report is to present an osseous foot lesion as the initial presentation of advanced metastatic adenocarcinoma. A 65-year-old female presented with 5 months of atraumatic left ankle pain. Initial radiographs and computed tomography scan showed a lytic lesion in the talar dome and calcaneus. Further workup and evaluation revealed diffuse metastatic disease in the lung, abdomen, and brain. A biopsy of the talar lesion demonstrated metastatic adenocarcinoma, and the patient elected to transition to hospice care less than 2 months after initial diagnosis. Although exceedingly rare, metastatic disease should be included in the differential for any lesion in the distal extremities including the foot and ankle. Unfortunately, these patients may have widespread metastases and poor prognosis at the time of initial presentation. This case report describes an acrometastasis of a primary adenocarcinoma and highlights the importance of considering metastatic disease in the differential of foot and ankle lesions. Delay in recognition and diagnosis of metastatic disease may have devastating consequences, and physicians could benefit from a high index of suspicion when treating these patients.
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Affiliation(s)
- Shrey Kanjiya
- Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
| | - Alireza Nazemi
- Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY.
| | - Megan Paulus
- Assistant Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Stony Brook University Hospital, Stony Brook, NY
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6
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Youlden DJ, Le B, Narulla R, Sehgol H, Molnar R, Sivakumar B, Symes M. Things are not always what they seem. A case of gastric adenocarcinoma metastasis to the toe. ANZ J Surg 2021; 92:267-269. [PMID: 34097334 DOI: 10.1111/ans.16999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel J Youlden
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Brian Le
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Rajpal Narulla
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Haider Sehgol
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Robert Molnar
- The Orthopaedic Research Institute & Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Brahman Sivakumar
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia.,Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Symes
- The Orthopaedic Research Institute & Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales Medicine, Sydney, New South Wales, Australia
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7
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Chen M, Tang H, Feng F. Percutaneous Osteoplasty for the Management of a Talar Metastasis: A Case Report. J Pain Res 2021; 14:1553-1557. [PMID: 34103980 PMCID: PMC8179796 DOI: 10.2147/jpr.s308379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background Talar metastasis is very rare among all bone metastases. Routine radiotherapy and chemotherapy are the main treatment measures at present. Nevertheless, some patients still experience unbearable cancer pain that cannot be effectively relieved with powerful painkillers. Case Report We report a patient with advanced renal carcinoma suffering from unbearable pain due to multiple bone metastases that involved several vertebrae (T11, L1, and L2) and the left talus. After percutaneous vertebroplasty in the vertebrae, the pain in the left talus became more prominent. We performed a percutaneous osteoplasty to manage the talar metastasis. Postoperatively, the pain level remarkably decreased, and the patient’s activity capacity significantly improved. Conclusion Percutaneous osteoplasty is an alternative method for talar metastasis that can alleviate pain immediately and improve the quality of life in patients with advanced malignant tumors.
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Affiliation(s)
- Mengmeng Chen
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hai Tang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fei Feng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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8
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Zdravkovic A, Mickel M, Crevenna R. Successful application of focused extracorporeal shockwave therapy for plantar fasciitis in patients suffering from metastatic breast cancer. Support Care Cancer 2021; 29:4187-4190. [PMID: 33745042 PMCID: PMC8236439 DOI: 10.1007/s00520-021-06117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Focused extracorporeal shock wave therapy (fESWT) has been shown to be effective in a large number of musculoskeletal disorders. Until 2016, cancer was considered a contraindication for fESWT. The goal of this Commentary is to address the subject of fESWT in cancer patients and present a case of a successful application of fESWT in a breast cancer patient with metastatic bone disease, suffering from debilitating heel pain caused by plantar fasciitis. METHODS The subject of fESWT application in cancer patients is discussed using the example of a 75-year-old female with breast cancer and metastatic bone disease suffering from bilateral inferior heel pain, who was referred to our clinic with a tentative diagnosis of polyneuropathy. Patient history, clinical examination, electrodiagnostic testing, and radiological findings all indicated plantar fasciitis, rather than polyneuropathy. The possibility of metastatic bone lesions in the treatment area was excluded and the patient was thereupon treated with 5 weekly applications of low-energy fESWT. RESULTS The treatment lead to a reduction in pain of approximately 80% with no adverse events. CONCLUSION fESWT may be a viable treatment option for plantar fasciitis even in cancer patients, provided certain conditions are met.
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Affiliation(s)
- Andrej Zdravkovic
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Michael Mickel
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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9
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Jiang S, Zhou H, Ma F, Shen H, Lu H. Acrometastasis of nasopharyngeal carcinoma: a case report. J Int Med Res 2021; 48:300060520924519. [PMID: 32436449 PMCID: PMC7287196 DOI: 10.1177/0300060520924519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Acrometastasis is an exceedingly rare condition and is often misdiagnosed or
overlooked. We herein describe a 50-year-old patient who developed
acrometastasis in the big toe from nasopharyngeal carcinoma. The treatment
consisted of amputation through the proximal phalanx, and the patient recovered
well. To our knowledge, only one case of acrometastasis from this origin has
been reported in the literature to date. Acrometastasis indicates a poor
prognosis, and we should choose appropriate treatment to relieve symptoms and
benefit the patient.
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Affiliation(s)
- Shuai Jiang
- Department of Orthopedic, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Haiying Zhou
- Department of Orthopedic, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Feixia Ma
- Department of Breast Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, P. R. China
| | - Hui Shen
- Department of Orthopedic, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Hui Lu
- Department of Orthopedic, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
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10
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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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11
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Grieser T. [Foot and ankle tumours : Part II: Malignant bone tumours and soft tissue tumours of the foot with differential diagnostic hints]. Radiologe 2019; 58:459-475. [PMID: 29492589 DOI: 10.1007/s00117-018-0361-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CLINICAL ISSUE Both benign and malignant tumours are encountered in the foot and ankle. Due to their rarity, however, diagnosis is often uncertain. Usual criteria such as tumour size, invasiveness or pain fail to differentiate benign from malignant neoplasias. STANDARD RADIOLOGICAL METHODS Plain radiography and-due to the complex foot anatomy-CT are important in the diagnostic evaluation of primary bone tumours. In the case of soft tissue tumours, ultrasonography is used to identify ganglion cysts. Tumour evaluation and staging are then performed using MRI. Nuclear imaging comes into play when multifocal, metastatic or systemic spread of the disease is suspected or if a biopsy procedure is planned. METHODICAL INNOVATIONS For the role of dual-energy CT, please refer to part I. Whether dual-energy CT is suitable to assess bone marrow oedema patterns is still debated. SPECIAL FEATURES OF FOOT AND ANKLE TUMOURS Primary bone tumours generally present in the ankle or the hindfoot. Malignant bone tumours, e. g. chondrosarcoma, are primarily found in the latter. On the other hand, soft tissue tumours generally present in the mid- and forefoot regions. ACHIEVEMENTS While the radiologic diagnostic evaluation of pedal bone tumours is quite reliable, caution is urgently needed in the case of soft tissue tumours because there are many confusing differential diagnoses. PRACTICAL RECOMMENDATIONS Proper X‑ray examination of the foot (at least in two plains) or with special views according to bony pathology is needed. All soft tissue masses that are not cysts should be evaluated further. MRI remains the diagnostic modality of choice but never stands alone! Caution: Size and well-defined margins of pedal soft tissue tumours are not considered criteria regarding whether a tumour is malignant or not.
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Affiliation(s)
- T Grieser
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
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12
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Perisano C, Vitiello R, Greco T, Cianni L, Maccauro G, Sfregola S, Gessi M, Mancino F. A report of a very rare isolated bone metastasis in the midfoot due to cervix cancer. MINERVA ORTOPEDICA E TRAUMATOLOGICA 2019; 70. [DOI: 10.23736/s0394-3410.19.03918-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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13
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El Abiad JM, Aziz K, Levin AS, McCarthy EM, Morris CD. Osseous Metastatic Disease to the Hands and Feet. Orthopedics 2019; 42:e197-e201. [PMID: 30602048 DOI: 10.3928/01477447-20181227-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/17/2018] [Indexed: 02/03/2023]
Abstract
Osseous metastases to the hands and feet (acrometastases) are exceedingly rare. Historically, the most common primary cancer observed has been lung carcinoma, treated either nonoperatively or with amputation. The aim of this study was to describe the clinical characteristics associated with acrometastases. This was a retrospective review of 28 patients with histologically proven osseous metastatic disease to the hands and feet. Variables recorded included primary cancer histology, age at diagnosis of primary and acrometastases, location of acrometastases, burden of disease, treatment, and age at death. Kaplan-Meier curves were used to estimate survival, and log-rank tests were used for comparison. The median age at acrometastases diagnosis was 61.5 years, and the most common associated primary cancer was lung carcinoma (n=9). Sixteen patients had acrometastases to the foot, and 12 had acrometastases to the hand. In the foot, most acrometastases were located in the tarsal bones (n=11), followed by the metatarsals (n=4) and the phalanges (n=3). In the hand, most were in the metacarpals and the phalanges (n=6 each), and 2 were in the carpals. The most common treatment was resection or curettage only (n=7). The median duration of survival after acrometastases diagnosis was 9.7 months. Despite advances in cancer treatment and shifting patterns of metastatic disease, there has been little change in the distribution of primary malignancies responsible for acrometastases, with lung carcinoma remaining the most common. Ablative procedures are rarely required, with limb-salvage interventions predominating. [Orthopedics. 2019; 42(2):e197-e201.].
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14
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Abstract
The foot and ankle delicately balance the need for support of the weight of the human body, with the need for flexibility. Palpable masses about the foot and ankle, therefore, are most commonly related to trauma or mechanical instability. Non-neoplastic causes, such as ganglion cysts and callus, therefore, predominate. However, the radiologist must be aware of the imaging appearance of less common benign and malignant neoplasms that can involve the foot and ankle.
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15
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Nasr L, Naffaa L, El Alayli A, Abboud MR, Khoury NJ. Isolated delayed metastasis to the talus from Ewing's sarcoma. J Radiol Case Rep 2018; 12:17-24. [PMID: 30651917 DOI: 10.3941/jrcr.v12i8.3164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Bone metastasis to the hands and feet, known as acrometastasis, is a very rare finding and tends to be associated with extensive metastasis. We herein report the case of a 14-year-old girl known to have a history of successfully treated Ewing's sarcoma arising from the ribs, who presented with a pathologically proven isolated metastatic lesion to the talus 7 years after achieving clinical and radiologic remission. We describe the imaging findings on MRI, CT scan and PET-CT. To our knowledge, talar metastasis from Ewing's sarcoma has been previously reported only twice in the English literature. Noteworthy is the fact that one of the previously reported lesions was considered a skip metastasis, and the other was under-described in terms of primary and secondary tumor location and time to metastasis. In addition, the overall imaging findings were rather suggestive of a benign lesion, particularly on CT scan.
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Affiliation(s)
- Layla Nasr
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
| | - Lena Naffaa
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
| | - Alaeddine El Alayli
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
| | - Miguel R Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil J Khoury
- Department Of Radiology, American University Of Beirut Medical Center, Beirut, Lebanon
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16
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Multifocal metastatic chordoma to the soft tissues of the fingertips: a case report including sonographic features and a review of the literature. Skeletal Radiol 2018; 47:401-406. [PMID: 28986658 DOI: 10.1007/s00256-017-2785-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 02/02/2023]
Abstract
Chordoma is a rare, locally aggressive tumor which commonly metastasizes, most often to the lung, liver, and spine. In this case report, a 59-year-old male with history of sacral chordoma and pulmonary metastases presented to the emergency department with swelling and discoloration of multiple left fingertips. The initial radiographs led to a presumptive diagnosis of gout, which did not respond to medical therapy. An ultrasound demonstrated multiple solid masses with vascular hyperechoic septations which were subsequently biopsied and proven to be metastatic chordoma. Metastatic disease to the hand is a well documented but rare manifestation of many malignancies. The clinical presentation and radiographic features of multifocal hand metastases may mimic entities such as systemic deposition and granulomatous diseases. To the best of our knowledge, this is the first case report of soft tissue chordoma metastases to the fingertips as well as the first reported sonographic description of chordoma metastases.
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17
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Tonogai I, Nishisho T, Miyagi R, Sairyo K. Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report. Foot Ankle Surg 2018; 24:e7-e12. [PMID: 29413783 DOI: 10.1016/j.fas.2017.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/02/2017] [Accepted: 06/22/2017] [Indexed: 02/04/2023]
Abstract
We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.
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Affiliation(s)
- Ichiro Tonogai
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Ryo Miyagi
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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18
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Multiple Acrometastases in a Patient with Renal Pelvic Urothelial Cancer. Case Rep Urol 2017; 2017:7830207. [PMID: 28758043 PMCID: PMC5512023 DOI: 10.1155/2017/7830207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 11/17/2022] Open
Abstract
Metastasis may occur in any bone but more commonly occurs in the spine, pelvis, or other axial bones. Metastasis in peripheral bones located distal to the elbow or knee, so-called acrometastasis, is rare. Although the mechanism of acrometastasis development is not completely understood, it is thought to be the result of a massive dissemination of cancer cells; thus the prognosis of patients with acrometastasis is relatively poor. Here, we report the case of renal pelvic cancer with multiple acrometastases in both the upper and lower extremities without axial bone metastasis in a 68-year-old man. After two regimens of chemotherapy, he suffered from pain on his wrist and ankle and swelling and hemorrhage of his toe. He had no axial bone metastasis by CT but was diagnosed with multiple acrometastases by plain radiographs. Radiation therapy and disarticulation of the left big toe at the metacarpal-phalangeal joint were performed and his pain and hemorrhage were successfully controlled. Although acrometastasis from renal pelvic cancer is very rare, we should recognize that acrometastasis might occur which exists outside of the CT scanning field.
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Aziz KT, McCarthy EF, Morris CD. Oncogenic Osteomalacia Secondary to a Metastatic Phosphaturic Mesenchymal Tumor in the Talus: A Case Report and Review of the Literature. JBJS Case Connect 2017; 7:e40. [PMID: 29244678 DOI: 10.2106/jbjs.cc.16.00172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We report the case of a 50-year-old woman with oncogenic osteomalacia secondary to a metastatic phosphaturic mesenchymal tumor (PMT) that presented, to our knowledge, with the first reported lesion in the talus. CONCLUSION Oncogenic osteomalacia is a rare condition with a unique serum biochemical profile that requires a high index of suspicion for diagnosis. A PMT is a rare neoplasm that can lead to oncogenic osteomalacia through secretion of fibroblast growth factor 23. Symptoms can be debilitating, and diagnostic delays are extremely common. This case report emphasizes the importance of comprehensive anatomic assessment and the need for fastidious postoperative monitoring.
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Affiliation(s)
- Keith T Aziz
- Departments of Orthopaedic Surgery (K.T.A.) and Pathology (E.F.M), and the Division of Orthopaedic Oncology (C.D.M.), The Johns Hopkins Hospital, Baltimore, Maryland
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Abstract
A 3-year-old boy with history of neuroblastoma underwent I-MIBG scan. The whole-body images showed relatively normal tracer distribution except for mild activity in the right foot, which was located in the first metatarsal on SPECT/CT images. The subsequent MRI scan of the right foot showed infiltration of the metatarsal of the right first toe. The findings were consistent with solitary acrometastasis of neuroblastoma to the great toe.
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Agha K, Akbari K, Abbas SH, Middleton S, McGrath D. Acrometastasis following colorectal cancer: A case report and review of literature. Int J Surg Case Rep 2016; 29:158-161. [PMID: 27863343 PMCID: PMC5118610 DOI: 10.1016/j.ijscr.2016.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/10/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Colorectal cancer commonly metastasises to the liver, peritoneum and lungs. Bony metastases are uncommon in colorectal cancer and in particular metastases to the hands or feet (acrometastasis) are an extremely rare occurrence. CASE PRESENTATION A 65-year-old male with a colonic malignancy underwent elective anterior resection. Intra-operatively he was found to have a pelvic collection necessitating an end colostomy. Histology confirmed complete Dukes B tumour excision with no evidence of lymph node metastases. The patient underwent chemo-radiotherapy but was unsuitable for reversal of Hartmann's due to elevated CEA levels and asymmetrical thickening of the rectal stump with a solitary lung nodule identified at a one-year surveillance CT. The lung nodule was resected revealing metastatic adenocarcinoma and biopsies from the rectal stump showed chronic inflammatory changes. The patient was offered further chemotherapy. However, six years after his original surgery the patient presented with an acutely painful left foot with radiographic appearances of an infiltrative sclerotic and lucent lesion confirmed as a calcaneal acrometastasis on Magnetic Resonance Imaging (MRI). DISCUSSION Diagnosis of acrometastasis is challenging and generally constitutes a wider metastatic process with poor prognosis. Patients are often asymptomatic or present with symptoms mimicking benign lesions such as arthritis, infection or ligamentous sprains of the hands or feet. Therefore, there should be a high index of suspicion and prompt radiological investigation is warranted in order to exclude disease recurrence. CONCLUSION Although acrometastasis may indicate a poor prognosis, timely diagnosis and intervention may facilitate improvement of long-term survival and symptomatic management.
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Affiliation(s)
- Kozar Agha
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom; West Midlands Deanery, Postgraduate School of Surgery, 213 Hagley Road, Edgbaston, B16 9RG, United Kingdom
| | - Khalid Akbari
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom
| | - Syed Husain Abbas
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom.
| | - Simon Middleton
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom
| | - Daniel McGrath
- Department of General Surgery, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, RG1 5AN, United Kingdom
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Abstract
A 63-year-old woman initially presented with progressive left foot pain for 3 months, not responding to conservative management. MRI of the left foot showed a suspicious lesion in calcaneus. An open biopsy was consistent with metastatic lung adenocarcinoma. Tc-MDP total-body bone scintigraphy was ordered for possible other bony lesions, and only left calcaneus lesion was identified on bone scan. CT scan of the chest revealed a soft tissue mass in the superior aspect of the right lower lobe. Staging FDG PET/CT showed hypermetabolic right lung mass and left calcaneus lesion. She received chemotherapy and local radiation to the left calcaneus metastatic lesion.
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23
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Lee CC, Wu YH. Paronychia-like digital metastases of osteosarcoma. Int J Dermatol 2016; 56:104-105. [DOI: 10.1111/ijd.13394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/10/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Chieh-Chi Lee
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
| | - Yu-Hung Wu
- Department of Dermatology; Mackay Memorial Hospital; Taipei Taiwan
- Mackay Medical College; New Taipei City Taiwan
- Mackay Medicine; Nursing and Management College; Taipei Taiwan
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Jeon JY, Chung HW, Kwon JW, Hong SH, Lee GY, Ryu KN. Imaging findings of various talus bone tumors-clinico-radiologic features of talus bone tumors. Clin Imaging 2016; 40:666-77. [PMID: 27317211 DOI: 10.1016/j.clinimag.2016.02.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Osseous neoplasms of the foot are uncommon, accounting for only 3.3% of all primary bone tumors. Bone tumors of the talus are even rarer, and there are not many publications that comprehensively evaluate the imaging findings of talus tumors. The purpose of this article is to review the benign and malignant bone tumors affecting this uncommon site and to describe the clinical and radiologic features of each tumor.
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Affiliation(s)
- Ji Young Jeon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center.
| | - Jong Won Kwon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea.
| | - Sung Hwan Hong
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Guen Young Lee
- Departments of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundanggu, Seongnam-si, Gyeonggi-do, 436-707, Korea.
| | - Kyung Nam Ryu
- Department of Radiology, Kyung Hee University Medical Center, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 130-702, Korea.
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Lung cancer presenting as a metastasis to the tibial bones: a case report. TUMORI JOURNAL 2015; 101:e18-20. [PMID: 25702675 DOI: 10.5301/tj.5000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2014] [Indexed: 11/20/2022]
Abstract
AIMS AND BACKGROUND Bone metastasis below the knee from primary lung cancer is rare. Discussion of such cases in a multidisciplinary team is important to establish the correct treatment approach. CASE REPORT We analyzed the diagnostic pathway of a 53-year-old female patient with a 5-month history of pain in the right foot. The patient underwent several radiological examinations for the pain. An initial diagnosis of osteoporotic syndrome was made, followed by a diagnosis of primary sarcoma. Only when the patient continued to have pain were other radiological examinations performed and a biopsy of the right ankle taken. This revealed a metastasis from undifferentiated pulmonary adenocarcinoma. A total-body computed tomography scan did not show any tumor locations apart from the primary lung cancer. The patient underwent chemotherapy and palliative therapies. This case has been reported for its rarity.
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27
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Abstract
Skeletal metastasis is common in patients with malignancy, but very few patients have acrometastasis, that is, metastasis to the hand or foot. We present 2 cases of acrometastasis from lung cancer where primary and metastatic foci were demonstrated on FDG-PET. The first case involves a 53-year-old man who complained of left foot pain and had osteolytic metastasis in the left calcaneus due to lung adenocarcinoma. True whole-body PET demonstrated lung cancer with calcaneal metastasis. Another case involves a 62-year-old man with large cell carcinoma of the right lung who complained of right wrist pain. Osteolytic metastasis of the hamate was demonstrated on images.
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Rice B, Ross J, Todd N, Caputo L, Rush S, Shrestha B. Pulmonary pleomorphic carcinoma metastasis to the midfoot. J Foot Ankle Surg 2014; 54:483-6. [PMID: 24840733 DOI: 10.1053/j.jfas.2014.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Indexed: 02/03/2023]
Abstract
Metastases to the bones in the foot are extremely uncommon, occurring in approximately 0.01% of all metastatic bone disease. We describe a case of an 82-year-old female with a metastatic pulmonary sarcomatoid carcinoma lesion to the midfoot. This rare and aggressive pulmonary malignancy has a poor prognosis. The purpose of the present case report was to highlight the key roles that medical history and biopsy, combined with a multispecialty approach, play in accurately diagnosing and appropriately treating a patient with metastatic bone disease.
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Affiliation(s)
- Brittany Rice
- Fourth Year Podiatry Student, Samuel Merritt University California School of Podiatric Medicine, Oakland, CA
| | - Justin Ross
- Fourth Year Podiatry Student, Samuel Merritt University California School of Podiatric Medicine, Oakland, CA
| | - Nicholas Todd
- Staff Podiatric Surgeon, Department of Orthopedics and Podiatric Surgery, Palo Alto Medical Foundation, Mountain View, CA.
| | - Louis Caputo
- Staff Podiatric Surgeon, Department of Orthopedics and Podiatric Surgery, Palo Alto Medical Foundation, Mountain View, CA
| | - Shannon Rush
- Staff Podiatric Surgeon, Department of Orthopedics and Podiatric Surgery, Palo Alto Medical Foundation, Mountain View, CA
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Zagrocki L, Ford TC, Willis WS, Sizemore HS. Metastatic bone cancer of the foot: a case report. J Am Podiatr Med Assoc 2014; 103:340-3. [PMID: 23878388 DOI: 10.7547/1030340] [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: 02/03/2023]
Abstract
Metastasis to the foot is rarely presented in the literature. We describe a 56-year-old woman with nonspecific pain in the left foot, ankle, and knee for 3 months. The patient was diagnosed as having urothelial carcinoma with metastasis to the left lower extremity, including the foot. This diagnosis was reached through the combined efforts of radiologic techniques and biopsies. This case discusses the importance of paying close attention to the details of the history and physical examination, performing appropriate tests, and obtaining suitable referrals.
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30
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Keskinbora M, Köse O, Karslioglu Y, Demiralp B, Basbozkurt M. Another cystic lesion in the calcaneus: benign fibrous histiocytoma of bone. J Am Podiatr Med Assoc 2014; 103:141-4. [PMID: 23536505 DOI: 10.7547/1030141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Benign fibrous histiocytoma is a rare benign primary skeletal tumor that occurs frequently in the long bones and the pelvis. The calcaneus is an unusual location for benign fibrous histiocytoma. We did not identify any case of benign fibrous histiocytoma involving the calcaneus in the relevant literature. We describe a 22-year-old male patient with benign fibrous histiocytoma involving the calcaneus treated with curettage and bone grafting. At the final follow-up visit, 1 year after surgery, the patient was free of pain and walking unaided. We discuss the differential diagnosis of cystic lesions of the calcaneus.
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Affiliation(s)
- Mert Keskinbora
- Orthopaedics and Traumatology Department, Gulhane Military Medical Academy, Ankara, Turkey
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Tew D, Duncan B, Chandrasekhar C. Referral to physical therapy of a previously undiagnosed ankle metastatic lesion. PM R 2013; 5:1081-3. [PMID: 24332232 DOI: 10.1016/j.pmrj.2013.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 07/18/2013] [Accepted: 07/19/2013] [Indexed: 11/20/2022]
Affiliation(s)
- Dana Tew
- Department of Rehabilitation-Physical Therapy Outpatient Orthopedics, Quentin Mease Community Hospital, Harris Health System, 3601 N MacGregor Way, no. 514, Houston, TX 77004(∗).
| | | | - Chitra Chandrasekhar
- Department of Diagnostic and Interventional Radiology, University of Texas Health Science Center, Houston, TX(‡)
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32
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Rice BM, Todd NW, Jensen R, Rush SM, Rogers W. Metastatic calcaneal lesion associated with uterine carcinosarcoma. J Foot Ankle Surg 2013; 53:364-8. [PMID: 23871174 DOI: 10.1053/j.jfas.2013.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Indexed: 02/03/2023]
Abstract
Metastatic lesions of uterine carcinosarcoma most commonly occur in the abdomen and lungs and less frequently in highly vascularized bone. We report a rare case of an 86-year-old female with uterine carcinosarcoma with metastasis to the left calcaneus. The patient had a history of uterine carcinosarcoma with hysterectomy and bilateral salpingo-oophorectomy, along with bilateral pelvic and aortic lymphadenectomy, with no adjuvant therapy. The initial pedal complaint was that of left foot pain. The initial radiographic findings were negative; however, magnetic resonance imaging scans revealed a substantial area of marrow edema in the calcaneus. An excisional biopsy was performed, and histopathologic analysis revealed adenocarcinoma with features consistent with the patient's previous uterine tumor specimen. The patient was given one treatment of chemotherapy and was discharged to a hospice, where she died of her disease 2 weeks later.
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Affiliation(s)
- Brittany M Rice
- Fourth Year Podiatry Student, California School of Podiatric Medicine, Samuel Merritt University, Oakland, CA
| | - Nicholas W Todd
- Staff Podiatric Surgeon, Department of Orthopedics and Podiatric Surgery, Palo Alto Medical Foundation, Mountain View, CA.
| | - Richard Jensen
- Staff Podiatric Surgeon, Department of Orthopedics and Podiatric Surgery, Palo Alto Medical Foundation, Mountain View, CA
| | - Shannon M Rush
- Staff Podiatric Surgeon, Department of Orthopedics and Podiatric Surgery, Palo Alto Medical Foundation, Mountain View Center, Mountain View, CA
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Ryder JH, McGarry SV, Wang J. Calcaneal acrometastasis from urothelial carcinoma of the ureter: a case report and literature review. Clin Interv Aging 2013; 8:395-9. [PMID: 23610517 PMCID: PMC3629866 DOI: 10.2147/cia.s42056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Ureteral cancer is a rare entity. Typical symptoms are painless hematuria as well as flank pain. Bone metastasis of ureteral cancer can occur in nearby bone structures, such as the spine, pelvis, and hip bone. Distal bone metastasis, such as that in the calcaneus bone, however, is rare. Case report An 82-year-old woman presented to the orthopedic clinic at the university hospital with a 3-month history of left heel pain. A magnetic resonance imaging (MRI) of her foot demonstrated a calcaneal lytic lesion. A biopsy of the lytic lesion showed urothelial carcinoma with squamous differentiation. A computed tomography (CT) scan of the abdomen and pelvis showed left hydronephrosis and an obstructive mass in the left ureter, at the iliac crossing. The patient received combined therapy that included local radiation, bisphosphonate, and chemotherapy, with complete resolution of her cancer-related symptoms. However, she eventually died from the progressive disease, 20 months after the initial diagnosis. Conclusion This case highlights the rare presentation of ureter cancer with an initial presentation of foot pain, secondary to calcaneal metastasis. Multimodality therapy provides effective palliation of symptoms and improved quality of life. We also reviewed the literature and discuss the clinical benefits of multidisciplinary cancer care in elderly patients.
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Affiliation(s)
- Jonathan H Ryder
- Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Abstract
UNLABELLED The authors present a case of a 62-year-old male with a symptomatic isolated midfoot metastasis as the first clinical presentation of a primary pulmonary tumor. In this case of a metastatic adenocarcinoma, the lesion leading to diagnosis was located in the foot. The poor outcome and the sparse relevant literature are presented in brief. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Choufani E, Diligent J, Galois L, Mainard D. Metastatic renal cell carcinoma presenting as foot metastasis: case report and review of the literature. J Am Podiatr Med Assoc 2011; 101:265-8. [PMID: 21622639 DOI: 10.7547/1010265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Malignant tumors frequently metastasize to bone centrally in the skeleton. Metastatic disease distal to the knee is unusual. Metastasis to the foot (acrometastasis) is rare (0.01%) and is usually a late manifestation of disseminated disease. The purpose of this article is to present a rare case of metastatic renal cell carcinoma with foot metastasis as the primary manifestation along with another rare localization of metastatic disease distal to the knee, in the contralateral tibial diaphysis. To highlight the delay in diagnosis of such a rare condition to consider it in the diagnosis of a painful foot, we also present a review of the literature.
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Affiliation(s)
- Elie Choufani
- Orthopedic Surgery and Traumatology, Central Hospital of Nancy, Nancy, France.
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Lanfranchi Debra MA, Lafforgue P, Pham T, Leydet Quilici H. Hallux metastasis revealing occult pulmonary squamous cell carcinoma. Joint Bone Spine 2011; 78:649-50. [PMID: 21723771 DOI: 10.1016/j.jbspin.2011.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
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Kaira K, Ayabe E, Takahashi T, Murakami H, Tsuya A, Nakamura Y, Naito T, Endo M, Takahashi M, Yamamoto N. Thenar muscle metastasis as recurrence of pulmonary squamous cell carcinoma. Asia Pac J Clin Oncol 2011; 7:15-6. [PMID: 21332646 DOI: 10.1111/j.1743-7563.2010.01373.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The clinical course of heel pain can be frustrating to the clinician and the patient. Most heel pain responds to conservative care in a short period of time. However, other causes should be considered, especially if the heel pain is recalcitrant to treatment. A detailed history and physical examination, along with appropriate laboratory tests and radiological studies, can direct the physician toward the correct diagnosis. There are many systemic causes of heel pain, some common and others uncommon. Regardless of the incidence, a strong index of suspicion is raised whenever the heel pain fails to respond as routine plantar fasciitis should.
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Affiliation(s)
- Eric Lui
- Connecticut Surgical Group, 85 Seymour Street #409, Hartford, CT 06106, USA.
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Gibbs DM, Esler CP, Ashford RU, Best A. Multifocal cementoplasty and internal fixation as a palliative procedure for skeletal metastases in the foot: a case report. J Foot Ankle Surg 2010; 49:489.e13-5. [PMID: 20418120 DOI: 10.1053/j.jfas.2010.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Indexed: 02/03/2023]
Abstract
Cementoplasty is a well-established intervention for symptomatic control of localized skeletal metastases; however, its use has never been reported for metastases in the foot. We report on a patient with symptomatic skeletal metastases throughout the foot in which cementoplasty, in conjunction with internal fixation, was used to alleviate pain and enable comfortable ambulation.
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Affiliation(s)
- David Mark Gibbs
- Trauma and Orthopaedic Surgery, Lincoln County Hospital, Lincolnshire, UK.
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Jakowski JD, Mayerson J, Wakely PE. Fine-needle aspiration biopsy of the distal extremities: a study of 141 cases. Am J Clin Pathol 2010; 133:224-31. [PMID: 20093231 DOI: 10.1309/ajcpbwjp3cg6jzka] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We reviewed our cytopathology databases for an 11-year period to identify all fine-needle aspiration biopsy (FNAB) cases of palpable masses of the hand, wrist, ankle, or foot. Cases were included only if there was a subsequent tissue biopsy or a minimum 1-year clinical follow-up. Of 141 aspirates, 41, 23, 34, and 43 were from the hand, wrist, ankle, and foot, respectively. Specific benign or malignant diagnoses were achievable in 71.6% of cases, whereas the remaining cases were given a descriptive diagnosis (26.2%) or, infrequently, a "suspicious for" diagnosis (2.1%). Overall sensitivity and specificity for distinguishing a benign from malignant entity from all 4 sites were 100% and 96%, respectively, whereas positive and negative predictive values were 88% and 100%, respectively. The most common lesion was a ganglion. Of the benign neoplasms, giant cell tumor of tendon sheath (17) and desmoid-type fibromatosis (7) were most common. Of 31 malignancies, 24 were sarcomas: sarcoma not otherwise specified (6), high-grade pleomorphic sarcoma (5), and Ewing sarcoma (3) were most common. Seven nonsarcomas included melanoma (3), metastatic squamous carcinoma (2), and malignant lymphoma (2). An FNAB-procured cytopathologic diagnosis is clinically reliable in a high percentage of distal extremity mass lesions.
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41
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Acrométastases de la main et du pied compliquant un cancer mammaire. ACTA ACUST UNITED AC 2010; 29:40-3. [DOI: 10.1016/j.main.2009.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 03/03/2009] [Accepted: 08/29/2009] [Indexed: 11/20/2022]
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Bibbo C, Hatfield SP, Albright JT. Treatment of metastatic prostate adenocarcinoma to the calcaneus. J Foot Ankle Surg 2009; 49:159.e15-20. [PMID: 20015665 DOI: 10.1053/j.jfas.2009.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Indexed: 02/03/2023]
Abstract
Metastatic skeletal adenocarcinoma is an all too common and unfortunate complication of advanced oncologic states. Mortality rates are usually elevated when bony metastasis are evident, as this signifies advanced disease. The foot and ankle are uncommon sites for metastatic deposits, but may occur. As such, the foot and ankle surgeon must be aware of the potential for such disease, and be able to proceed with an imaging and medical work-up of the patient with foot and ankle skeletal metastasis. The goal of treatment is pain relief and the preservation of functional ambulation, which may greatly enhance the quality of remaining life for patients. A team approach is mandatory to manage the patients with metastatic disease. We present a case of an elderly male with a known history of prostate cancer, who presented with unrelenting heel pain, which upon diagnostic work-up, proved to be progressive calcaneal as well as axial metastasis after a brief period of clinical remission. Operative management coupled with palliative radiation and bisphosphonate therapy provided symptomatic pain relief and maintenance of functional ambulation.
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Affiliation(s)
- Christopher Bibbo
- Foot & Ankle Section, Department of Orthopaedics, Marshfield Clinic, Marshfield, WI, USA.
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43
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Gaston CLL, Vergel de Dios AM, Dela Rosa TL, Wang EHM. Case report: Primary squamous cell carcinoma of a tarsal bone. Clin Orthop Relat Res 2009; 467:3346-50. [PMID: 19526272 PMCID: PMC2772939 DOI: 10.1007/s11999-009-0926-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 05/28/2009] [Indexed: 01/31/2023]
Abstract
We describe a rare case of primary squamous cell carcinoma of the cuneiform bone of the foot in a 57-year-old man. In the appendicular skeleton, epithelial carcinomas of bone are usually metastatic deposits, primary squamous cell carcinomas of bone being found more frequently in the skull. A review of the English literature revealed only two other reported cases of primary squamous cell carcinoma outside the skull--one in the ilium and one in the tibia. In our patient, extensive metastatic workup and monitoring during more than 2 years showed no primary focus, supporting the rare presentation of a primary squamous cell carcinoma of bone in the appendicular skeleton.
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Affiliation(s)
- Czar Louie L. Gaston
- Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Ariel M. Vergel de Dios
- Department of Pathology, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Tammy L. Dela Rosa
- Hand and Microvascular Service, Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Edward H. M. Wang
- Tumor Service, Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Manila, 1000 Philippines
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Bone scintigraphic images of a patient with unusual metastatic alveolar soft-part sarcoma. Clin Nucl Med 2009; 34:806-7. [PMID: 19851182 DOI: 10.1097/rlu.0b013e3181b81cf6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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