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Pullay Silven M, Encarnación-Santos DA, Volovish A, Nicoletti GF, Iacopino DG, Valerievich KA. Letter to the Editor Regarding "Targeting the Future: Developing a Training Curriculum for Robotic Assisted Neurosurgery". World Neurosurg 2024; 184:345-346. [PMID: 38590058 DOI: 10.1016/j.wneu.2023.12.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 04/10/2024]
Affiliation(s)
- Manikon Pullay Silven
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Alexander Volovish
- Division of Vertebrology of NCC No. 2 (CCB RAS) FGBNU, RNTSKH in B.V. Petroskovo Academy, Moscow, Russia
| | | | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Kim-A Valerievich
- Deparment of Neurosurgery, City Clinical Hospital No. 68 Gbuz Gkb Im. V.P. Demikhova (RUDN University), Moscow, Russia
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Naous R. Pulmonary squamous cell carcinoma metastatic to the proximal interphalangeal joint of the right finger: report of a rare case and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2024; 17:22-26. [PMID: 38322175 PMCID: PMC10839247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/30/2023] [Indexed: 02/08/2024]
Abstract
Synovial metastasis is a rare condition with only a few cases reported in the literature. Synovial metastasis to the finger or toe joint is different from acrometastasis, which is defined as bone metastasis located distal to the elbow and knee. The most common site of synovial metastasis is the knee joint. Conversely, synovial metastasis to the finger or toe joints has, to our knowledge, been reported in one case only so far. Herein, we report the second case of synovial metastasis to the proximal interphalangeal joint of the right third finger in a patient with metastatic pulmonary squamous cell carcinoma and review the literature on synovial metastasis.
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Affiliation(s)
- Rana Naous
- Department of Pathology, University of Pittsburgh Medical Center Pittsburgh, PA, USA
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Pușcașu AI, Moinard-Butot F, Antoni D, Schott R, Somme L. Solitary acrometastasis of the phalanx as initial presentation of an oligometastatic Kirsten rat sarcoma viral oncogene homolog-mutated lung adenocarcinoma: a case report. J Med Case Rep 2023; 17:395. [PMID: 37718451 PMCID: PMC10506272 DOI: 10.1186/s13256-023-04127-1] [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] [Received: 04/24/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Acrometastasis is an uncommon finding in non-small cell lung cancer and is usually a sign of multimetastatic disease. Few case reports have suggested solitary digital metastasis as the single secondary lesion of oligometastatic non-small cell lung cancer. CASE PRESENTATION This case report describes an unusual presentation of a Kirsten rat sarcoma viral oncogene homolog-mutated lung adenocarcinoma with a solitary bone metastasis in the fourth finger medial phalanx, which was also the first sign of the disease, in a 63-year-old Caucasian female patient. Digital surgical amputation was performed. After histopathological confirmation and radiological exclusion of other secondary lesions, chemoimmunotherapy in a first-line setting was initiated. A partial metabolic response in the primary lung lesion was observed after four cycles. Maintenance therapy is currently being continued. CONCLUSION Solitary digital metastasis is a rare finding in non-small cell lung cancer. Further studies are needed to investigate the mechanisms behind this particular dissemination process.
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Affiliation(s)
- Alexandra-Ioana Pușcașu
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg, France.
| | - Fabien Moinard-Butot
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg, France
| | - Delphine Antoni
- Radiation Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg, France
| | - Roland Schott
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg, France
| | - Laura Somme
- Medical Oncology Department, Institut de Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg, France
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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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Dow T, Davis C, ElAbd R, Lalonde D, Williams J. Cancer Metastases to the Hand: A Systematic Review and Meta-analysis. Hand (N Y) 2023:15589447231153175. [PMID: 36856295 DOI: 10.1177/15589447231153175] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. METHODS An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. RESULTS Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. CONCLUSION Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.
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Affiliation(s)
- Todd Dow
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada
| | - Caitlin Davis
- Department of Obstetrics and Gynecology, Dalhousie Unviersity, Halifax, NS, Canada
| | - Rawan ElAbd
- Division of Plastic and Reconstructive Surgery, McGill Univeristy, Montreal, Canada
- Division of Plastic and Reconstructive Surgery, Jaber Al Ahmed Al Jaber Al Sabah Hopsital, Surra, Kuwait
| | - Donald Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, NB, Canada
| | - Jason Williams
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, NS, Canada
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Pan Z, Zhao Y, Jiang P. Vascularized Composite Iliac Flap Grafting for Trapezial Metastasectomy in Clear Cell Renal Carcinoma: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00057. [PMID: 36893284 DOI: 10.2106/jbjs.cc.22.00628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
CASE Renal cell carcinoma (RCC) metastases rarely occur in the trapezium. We present the case of a 69-year-old man with clear cell RCC metastasis to the trapezium. After tumor resection, bone and soft-tissue defects were reconstructed with a vascularized osseo-fascio-fat composite iliac flap. Four years later, sorafenib was administered to treat subsequent pulmonary and femoral metastases. CONCLUSION At the 7-year follow-up, neither local recurrence nor additional metastatic sites were observed. The affected wrist could perform 50° of extension and 40° of flexion. The patient could use his right thumb in daily activities without pain.
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Affiliation(s)
- ZhaoHui Pan
- Institute of Orthopaedic Trauma Surgery of the Chinese People's Liberation Army, 80th Group Military Hospital, Weifang, China
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Aneurysmal bone cyst of the spine in adult patients: A systematic review and comparison of primary vs secondary lesions. J Clin Neurosci 2022; 100:15-22. [DOI: 10.1016/j.jocn.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/26/2022] [Indexed: 11/19/2022]
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Metastatic cancer in an uncommon location: importance of clinico-pathological correlation. Acta Gastroenterol Belg 2022; 85:408-409. [DOI: 10.51821/85.2.10156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acrometastasis is an uncommon metastatic location appearing in the small bones of hands and feet (1). Its low incidence, around 0,1% of all bone metastases, may be due to the subclinical presentation and the lack of attention to the extremities in routine examination (1- 5). However, it sometimes represents the first expression of an occult malignancy (1-4). The symptoms are aspecific and may mimic a local infection, an inflammatory disease (arthritis, tenosynovitis) or a dermatologic lesion (1-5). The correct diagnosis of this atypical entity is important to draw the attention of the clinicians to the metastatic dissemination of the disease, to initiate adequate treatment and reduce patient morbidity.
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Palmisciano P, Balasubramanian K, Scalia G, Sagoo NS, Haider AS, Bin Alamer O, Chavda V, Chaurasia B, Deora H, Passanisi M, Da Ros V, Giammalva GR, Maugeri R, Iacopino DG, Cicero S, Aoun SG, Umana GE. Posterior epidural intervertebral disc migration and sequestration: A systematic review. J Clin Neurosci 2022; 98:115-126. [PMID: 35152147 DOI: 10.1016/j.jocn.2022.01.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Posterior epidural intervertebral disc migration and sequestration (PEIMS) is a rare and debilitating complication of degenerative disc disease. Radiological differential diagnosis is often challenging, complicating the accurate planning of appropriate treatment strategies. We systematically reviewed the literature on PEIMS, focusing on clinical-radiological features and available treatments. PubMed, Scopus, Web of Science, and Cochrane were searched to include studies reporting clinical data of patients with PEIMS. Clinical characteristics, treatment strategies, and functional outcomes were analyzed. We included 82 studies comprising 157 patients. Median age was 54 years (range, 19-91). PEIMSs occurred spontaneously (49.7%) or acutely in patients with underlying progressive degenerative disc disease (50.3%). The most common symptoms were lower-back pain (77.1%) and radiculopathy (66.2%), mainly involving the L5 nerve root (43.8%). PEIMSs were mostly detected at MRI (93%) and/or CT (7%), frequently located in the lumbar spine (81.5%). Median maximum PEIMS diameter was 2.4 cm (range, 1.2-5.0). Surgical debulking was completed in 150 patients (95.5%), sometimes coupled with decompressive laminectomy (65%) or hemilaminectomy (19.1%). Median follow-up time was 3 months (range, 0.5-36.0). Post-treatment symptomatic improvement was reported in 153 patients (97.5%), with total recovery in 118 (75.2%). All 7 patients (4.5%) who received conservative non-surgical management had total clinical recovery at ≤ 3 months follow-ups. PEIMS is a challenging entity that may severely quality-of-life in patients with degenerative disc disease. Surgical removal represents the gold standard to improve patient's functional status. Spine fusion and conservative strategies proved to be effective in some cases.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | | | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy
| | - Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, TX, USA
| | - Othman Bin Alamer
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Vishal Chavda
- Division of Anaesthesia, Sardar Women's Hospital, Ahmedabad, Gujarat, India
| | - Bipin Chaurasia
- Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Maurizio Passanisi
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University Hospital of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe R Giammalva
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Domenico G Iacopino
- Unit of Neurosurgery, Department of Biomedical Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Salvatore Cicero
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy.
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Primary Paraganglioma of the Spine: A Systematic Review of Clinical Features and Surgical Management in Cauda Equina vs Non-Cauda Equina Lesions. World Neurosurg 2022; 161:190-197.e20. [PMID: 35123022 DOI: 10.1016/j.wneu.2022.01.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Primary spine paragangliomas are rare tumors. Surgical resection plays a role, but aggressive lesions are challenging. We reviewed the literature on primary spine paragangliomas. METHODS PubMed, Scopus, Web of Science, and Cochrane were searched upon the PRISMA guidelines to include studies on primary spine paragangliomas. Clinical-radiological features, treatments, and outcomes were analyzed and compared between cauda-equina vs non-cauda-equina tumors. RESULTS We included 143 studies comprising 334 patients. Median age was 46 years (range, 6-85). The most frequent symptoms were lower-back (64.1%) and radicular (53.9%) pain, and sympathetic in 18 patients (5.4%). Cauda-equina paragangliomas (84.1%) had frequently lumbar (49.1%) or lumbosacral (29%) locations. Non-cauda-equina tumors were mostly in the thoracic (11.4%), thoracolumbar (5.1%), and cervical (3.6%) spine. Median tumor diameter was 2.5cm (range, 0.5-13.0). Surgical resection (98.5%) was preferred over biopsy (1.5%). Decompressive laminectomy (53%) and spine fusion (6.9%) were also performed. Adjuvant radiotherapy was delivered in 39 patients (11.7%) with aggressive tumors. Post-treatment symptomatic improvement was described in 86.2% cases. Median follow-up was 19.5 months (range, 0.1-468.0), and 23 patients (3.9%) had tumor recurrences. No significant differences were found between cauda-equina vs non-cauda-equina tumors. CONCLUSION Surgical resection is effective and safe in treating primary spine paragangliomas; however, adjuvant treatments may be needed for aggressive lesions.
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Haider AS, Palmisciano P, Sagoo NS, Bin Alamer O, El Ahmadieh TY, Pan E, Garzon-Muvdi T. Primary Central Nervous System Sarcomas in Adults: A Systematic Review. Clin Neurol Neurosurg 2022; 214:107127. [DOI: 10.1016/j.clineuro.2022.107127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/04/2022] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
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Umana GE, Scalia G, Palmisciano P, Passanisi M, Pompili G, Amico P, Ippolito M, Sabini MG, Cicero S, Perrotta R. Spontaneous sacral fracture with associated acrometastasis of the hand. Surg Neurol Int 2021; 12:534. [PMID: 34754584 PMCID: PMC8571185 DOI: 10.25259/sni_917_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Acrometastases, secondary tumors affecting oncological patients with systemic metastases, are associated with a poor prognosis. In rare cases, acrometastases may precede establishing the primary tumor diagnosis. Case Description: A 72-year-old female heavy smoker presented with low back pain, and right lower extremity sciatica/radiculopathy. X-rays, CT, MR, and PET-CT scans documented primary lung cancer with multi-organ metastases and accompanying pathological fractures involving the sacrum (S1) and right 4th digit. She underwent a S1 laminectomy and amputation of the distal phalanx of the right fourth finger. The histological examination documented a poorly differentiated pulmonary adenocarcinoma infiltrating bone and soft tissues in the respective locations. The patient was treated with a course of systemic immunotherapy (i.e. pembrolizumab). At 6-month follow-up, the patient is doing well and can stand and walk without pain. Conclusion: Spontaneous sacral fractures may be readily misdiagnosed as osteoporotic and/or traumatic lesions. However, in this case, the additional simultaneous presence of a lytic finger lesion raised the suspicion that these were both metastatic tumors. Such acrometastases, as in this case attributed to a lung primary, may indeed involve the spine.
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Affiliation(s)
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Sicily, Italy
| | | | - Maurizio Passanisi
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi," Sicily, Italy
| | | | - Paolo Amico
- Department of Pathological Anatomy, Cannizzaro Hospital, Sicily, Italy
| | - Massimo Ippolito
- Department of Advanced Technologies, Nuclear Medicine and PET, Cannizzaro Hospital, Sicily, Italy
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