Massive trapezial metastasis from gastric adenocarcinoma resected and reconstructed with a vascularized scapular bone graft: A case report

Vascularized Composite Iliac Flap Grafting for Trapezial Metastasectomy in Clear Cell Renal Carcinoma: A Case Report

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.

Trapezial Acrometastasis as the First Presentation of Occult Lung Cancer: A Case Report

CASE

Acrometastasis is extremely rare, accounting for 0.1% of all skeletal metastases. Metastases to the carpus are rarer still. This condition can be the first manifestation of an occult malignancy and generally indicates advanced disease. We present the case of a 53-year-old woman with acrometastasis of squamous cell lung cancer to the trapezium as the initial presentation of her malignancy.

CONCLUSION

The presentation of acrometastasis can mimic infectious or inflammatory processes, leading to an erroneous diagnosis. Although exceptionally uncommon, it is important to consider as a differential diagnosis for a destructive hand lesion.

Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them

Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have been reported in the literature. Nevertheless, it is unclear how the metastatic sites may affect the prognosis. In particular, knowledge about the impact of bone metastases on GC patients’ outcome is scant, and this may be related to the rarity of bone lesions and/or their underestimation at the time of diagnosis. In fact, there is still a lack of specific recommendation for their detection at the diagnosis. Then, the majority of the evidences in this field came from retrospective analysis on very heterogeneous study populations. In this context, the aim of this narrative review is to delineate an overview about the evidences existing about bone metastases in GC patients, focusing on their incidence and biology, the prognostic role of bone involvement, and their possible implication in the treatment choice.

Distal phalanx: an unusual site for a gastric adenocarcinoma metastasis

Gastric adenocarcinoma typically metastasises to the liver, peritoneum and lung. Bone metastasises are less frequent and particularly uncommon in the distal extremities. This is an unusual case of metastatic disease in the distal phalanx mimicking the presentation of osteomyelitis. This case highlights the need to remain vigilant in patients with known cancer and to always be mindful of metastatic disease, even if the presentation is atypical.