Osseous metastases in the hand. A general review of three cases

Metastatic tumour of the hand - Three new cases and a literature review

Metastatic tumours of the hand are rare, and therefore, is the subject of only a few publications in the literature. We report on three new cases along with a retrospective and descriptive study with file and literature analysis dating from 1900 to 2017, which reported on 337 studies. To perform the statistical analysis, ordinary lease square regression was used to group the metastases into distal phalanx, proximal/middle phalanx, thumb, hand and carpus. We found 564 metastases at the hand for a total of 482 patients. Of the reported cases, 60% were male. The average age was 59 years. The main primary cancers were lung cancer (40%), followed by gastrointestinal (19%), genito-urinary (13%), gynaecological (11%) and ear, nose and throat (6%) cancers. The mean survival time was 7.2 months. Fifty-nine per cent was bone metastasis, 18% tissue metastasis and 3% cutaneous metastasis. In 20% of cases, the type of metastasis was not mentioned. Of all the tissue metastases, 47 (54%) were subungual and in that group, the thumb was the finger most commonly affected. Overall, metastases most commonly appeared in the distal phalanx, which can be explained by a greater vascularisation as well as microtraumatisms. Survival was independent of the epidemiological criteria and of the location and type of metastasis. Patients with primary urological cancer lived on average 3 months longer than patients with other types of primary cancers.

Lung Metastasis Mimicking Fingertip Infection

Metastasis fingers (acral metastasis) are finding a poor prognosis. Past medical history should be questioned and metastasis from primary tumor should be kept in mind in patients with pain, swelling, and hyperemia in fingers. Successful surgical treatment on acral metastasis does not extend the life expectancy; however, it reduces the patient's pain during his terminal period, saves the functions of the limb, and increases life comfort.

A finding with a diagnosis: I just can't put my finger on it

A 72-year-old man with metastatic squamous cell carcinoma of the lung presents with new lesions in the distal phalanx of right fifth finger (painful) and left great toe (painless due to long-standing peripheral neuropathy). Initially a complication of cytotoxic chemotherapy is considered and a dermatological opinion is requested. Enlargement of the lesions over the space of a week leads to plain X-ray, with findings of destruction of the distal phalanx of the involved digits confirming metastatic disease. Palliative radiotherapy is administered to decrease pain and reduce the likelihood of cutaneous and infectious complications. The patient died from systemic disease progression soon after finishing his radiotherapy. Digital metastasis (acrometastasis) should be considered by clinicians in the workup of patients with persistent digital symptoms, particularly in those with known cancer or those at high risk of cancer.

Lung cancer presenting as acrometastasis to the finger: a case report

Lung cancer is the commonest cause of acrometastatic disease to the fingers. Here we describe a case of occult lung cancer presenting as unrelenting finger pain and swelling from a metastatic phalangeal fracture. The patient's management was largely palliative and he died soon after discovery of the primary tumor. Digital acrometastatic disease rarely becomes symptomatic before the primary lung cancer is diagnosed and, as observed in this case, carries a very poor prognosis. Clinicians should be cognizant of the strong association between digital acrometastases and bronchogenic carcinoma and vigilant in screening high-risk patients with importunate finger symptoms.

Two cases of acrometastasis to the hands and review of the literature

This paper reports two cases of acrometastasis to the hands. The first case involved a 78-year-old woman with a permeative osteolytic lesion in her proximal second metacarpal. A biopsy of this lesion suggested a diagnosis of non-small-cell lung carcinoma with secondary osseous metastasis. This was the first presentation of the woman’s primary diagnosis. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient’s left hand. The treatment proved successful: the woman soon experienced pain relief and regained the use of her hand. The second case involved a 69-year-old woman with extensive lytic destruction involving the proximal two thirds of her third metacarpal. This patient had been diagnosed with carcinoma of the breast in 1990. She also received a single 8-Gy fraction of radiation, which improved both her pain and her hand mobility.

An extensive review of the literature uncovered 257 previously reported cases of acrometastasis. Articles were analyzed based on age and sex of the patient, site of the primary carcinoma, metastatic locations within the hand and affected appendage or appendages, the treatment given, and the patient’s length of survival. Men were almost twice as likely to experience acrometastasis as women, and the median age of the patients overall was 58 years (range: 18 months–91 years). Lung, kidney, and breast carcinoma were the three most prevalent primary diagnoses reported in the literature. Cancers of the colon, stomach, liver, prostate, and rectum affected the remainder of the population.

Overall, the right hand was more often host to the metastatic lesions. In addition, almost 10% of the patients experienced lesions in both hands. The third finger was the digit most affected by osseous metastases reported in the literature. Lesions of the thumb, fourth finger, second finger, and fifth finger were less commonly reported. The region of the digit most often affected within the patient population was the distal phalanx. The metacarpal bones, proximal phalanges, and middle phalanges comprised the remainder of the four most frequent acrometastatic sites. In the literature, single lesions were more prevalent than multiple bony lesions.

Based on the reported cases, amputation appeared to be the preferred method of treatment. Radiation, excision, and systemic therapy were the next most frequently used treatments. Patient survival was not well documented within the literature. However, the median survival of patients in the reported cases was 6 months. Thus, our review suggested that a diagnosis of hand metastasis is an indication of poor prognosis.

This report serves to emphasize the importance of properly diagnosing acrometastases. Identifying and effectively treating these metastases in a timely manner can lead to a dramatic improvement in a patient’s quality of life.

Extensive metastasis to the hand from undiagnosed adenocarcinoma of the lung

Metastatic tumours of the hand are uncommon; we present a case of undiagnosed adenocarcinoma of the lung with extensive metastases to the carpal, and to the third, fourth, and fifth metacarpal, bones. Biopsy confirmed the diagnosis and the patient died three months later, no surgical treatment being offered.

Acrométastase du pouce révélant un adénocarcinome pulmonaire : à propos d'un cas avec revue de la littérature

Bone metastases in the hand and foot bone (acrometastases) are rarely observed. The authors report a case of a 57-years-old man diagnosed as hand tumour, revealing a bronchic adenocarcinoma. Radiography showed destruction of the phalanx, and histology study confirmed a metastasis of the lung cancer.

Metastatic carcinoma to the terminal phalanx of the big toe: report of two cases and review of the literature

Metastasis to the distal phalanges of the fingers and toes is rare and is associated with a poor prognosis. Phalangeal metastases commonly display inflammatory symptoms that mimic an acute infection. We describe two men with metastasis to the distal phalanx of the great toe. A review of the literature revealed 118 cases of nonmelanoma metastatic tumors to a distal digit.

[Metastatic tumors of the soft tissues of the hand. Apropos of a case. Review of the literature]

Soft tissue metastases of the hands are rare tumours, representing 0.1% of all metastases. The authors report a personal case and review the literature concerning another 21 cases. The primary tumour is generally a lung or breast cancer. These metastases appear to be more frequent in men than in women. Their rarity can be explained by the absence of routine investigation of such sites. The development of such metastases always indicates a poor prognosis.

Chondromas of the hand. A report of thirty-five cases

Twenty-nine patients were treated in the department of orthopedic surgery of Purpan (Toulouse), with thirty-five chondromata of the hand. Follow-up was over one year. Chondroma is a bone tumor predominantly of the left side, second ray of the hand and phalanx. Some multifocal cases have been observed. The diagnosis was made in half the cases through a pathological fracture. Chondroma is characterized by a diaphyseal or a metaphyso-diaphyseal lacuna, wearing away the cortical bone. Treatment consisted of curetting the tumor and filling the cavity with iliac cancellous bone graft. The clinical result was been excellent in 15 cases (60%), good in 6 cases (25%), with only some residual pain, and/or digital swelling. In two cases the finger was stiff, but functionally not disabling. In one case the stiffness was important and very disabling; after several recurrences it evolved into a chondrosarcoma.

Metastatic tumors in the hand from adenocarcinoma of the colon

Osseous metastases to the hand are rare. The primary site is usually in the lung, breast, or kidney. Two cases of metastatic tumor in the hand from adenocarcinoma of the colon are reported herein. These patients presented two and four years after initial resections of colonic carcinomas. General aspects of diagnosis, etiology, and management are discussed.