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Acrometastases to the Hand: A Systematic Review. MEDICINA-LITHUANIA 2021; 57:medicina57090950. [PMID: 34577873 PMCID: PMC8471162 DOI: 10.3390/medicina57090950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. Material and Methods: A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. Results: In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10–91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5–39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7–156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Conclusions: Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.
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Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them. J Clin Med 2021; 10:jcm10081777. [PMID: 33921760 PMCID: PMC8073984 DOI: 10.3390/jcm10081777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/28/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
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.
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Harris H, Khan M, Jaunoo S. Distal phalanx: an unusual site for a gastric adenocarcinoma metastasis. BMJ Case Rep 2020; 13:13/9/e236259. [PMID: 32912891 DOI: 10.1136/bcr-2020-236259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Holly Harris
- Trauma and Orthopaedics, Royal Sussex County Hospital, Brighton, UK
| | - Mansoor Khan
- General Surgical Department, Royal Sussex County Hospital, Brighton, UK
| | - Shameen Jaunoo
- General Surgical Department, Royal Sussex County Hospital, Brighton, UK
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Assi R, Mukherji D, Haydar A, Saroufim M, Temraz S, Shamseddine A. Metastatic colorectal cancer presenting with bone marrow metastasis: a case series and review of literature. J Gastrointest Oncol 2016; 7:284-97. [PMID: 27034798 DOI: 10.3978/j.issn.2078-6891.2015.092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
With advances in treatment, patients with metastatic colorectal cancer (CRC) are now living longer with an apparent increase in the incidence of bone and bone marrow metastases (BMM). Common sites of metastatic disease from CRC include the liver and lungs with bone metastasis rarely occurring in the absence of visceral metastatic disease. We report a series of three patients presenting with isolated bone and BMM leading to a diagnosis of primary CRC. We have reviewed the literature regarding diagnosis, potential mechanisms leading to the development of osseous metastasis and outcome. A high level of clinical suspicion and in-depth understanding of the natural history of these rare metastases may guide future management and treatment decisions.
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Affiliation(s)
- Rita Assi
- 1 Department of Internal Medicine, Division of Hematology-Oncology, 2 Department of Radiology, 3 Department of Pathology, American University of Beirut Medical Center, Beirut 1103, Lebanon
| | - Deborah Mukherji
- 1 Department of Internal Medicine, Division of Hematology-Oncology, 2 Department of Radiology, 3 Department of Pathology, American University of Beirut Medical Center, Beirut 1103, Lebanon
| | - Ali Haydar
- 1 Department of Internal Medicine, Division of Hematology-Oncology, 2 Department of Radiology, 3 Department of Pathology, American University of Beirut Medical Center, Beirut 1103, Lebanon
| | - Maya Saroufim
- 1 Department of Internal Medicine, Division of Hematology-Oncology, 2 Department of Radiology, 3 Department of Pathology, American University of Beirut Medical Center, Beirut 1103, Lebanon
| | - Sally Temraz
- 1 Department of Internal Medicine, Division of Hematology-Oncology, 2 Department of Radiology, 3 Department of Pathology, American University of Beirut Medical Center, Beirut 1103, Lebanon
| | - Ali Shamseddine
- 1 Department of Internal Medicine, Division of Hematology-Oncology, 2 Department of Radiology, 3 Department of Pathology, American University of Beirut Medical Center, Beirut 1103, Lebanon
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Afshar A, Farhadnia P, Khalkhali H. Metastases to the hand and wrist: an analysis of 221 cases. J Hand Surg Am 2014; 39:923-32.e17. [PMID: 24612837 DOI: 10.1016/j.jhsa.2014.01.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify demographic trends, survival rates, the most common metastatic locations, and the most common primary malignant tumors in the reports of hand and wrist metastases published over the past 27 years. METHODS A keyword search was performed across PubMed, Google, Science Direct, and Springer databases with a time-range restriction set between April 1986 and April 2013. A total of 193 articles were located describing 221 patients. The data were analyzed for patient age, sex, known history of malignancy, primary tumor site, histological diagnosis, metastatic location, hand involvement, and survival rates. RESULTS Lung, gastrointestinal tract, and kidney malignancies were the 3 leading metastatic tumors. The mean age among patients was 61 ± 13 years, and involvement among men was almost twice as common as among women. The mean survival from the time of the diagnosis was 7 ± 7 months. There were no predilections for either the right or the left hand. The distal phalanx was the most frequently involved bone, and the thumb was the most frequently involved digit. CONCLUSIONS The frequency of published hand and wrist metastasis has increased dramatically within the last decade. Metastases have been reported for every bone of the hand and wrist as well as for the soft tissues. Compared with the previous studies, the mean age of reported patients has slightly increased even though the mean survival time has not changed. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.
| | - Payam Farhadnia
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Hamidreza Khalkhali
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran; Department of Biostatistics and Epidemiology, Urmia University of Medical Sciences, Urmia, Iran; University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
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Borobio León G, García Plaza A, García Cepeda I, González Alconada R, Hernández Cosido L. Metástasis en mano de adenocarcinoma de recto. Un caso excepcional. Cir Esp 2010; 88:195-7. [DOI: 10.1016/j.ciresp.2009.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
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Flynn CJ, Danjoux C, Wong J, Christakis M, Rubenstein J, Yee A, Yip D, Chow E. Two cases of acrometastasis to the hands and review of the literature. ACTA ACUST UNITED AC 2010; 15:51-8. [PMID: 19008991 PMCID: PMC2582515 DOI: 10.3747/co.v15i5.189] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- C J Flynn
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON
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Bigot P, Desbois E, Benoist N, Besnier L, Moui Y. Acrométastase révélée par une douleur isolée de la main. À propos d’un cas. ACTA ACUST UNITED AC 2007; 26:300-2. [DOI: 10.1016/j.main.2007.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 09/14/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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Bahk WJ, Rhee SK, Kang YK, Lee AH, Park JM, Chung YG. Gastric cancer acrometastases to all digits of one hand following closed intramedullary nailing. Skeletal Radiol 2006; 35:529-32. [PMID: 16283175 DOI: 10.1007/s00256-005-0047-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 09/15/2005] [Accepted: 09/17/2005] [Indexed: 02/02/2023]
Abstract
Metastatic malignant tumor of the hand is unusual and the most common site of the primary cancer is lung. Acrometastases to the phalanges of the hand usually involve a single bone, while those proximal to the phalanges often involve multiple bones. Metastasis to the hand from gastrointestinal cancer, particularly from gastric cancer, is extremely rare. To our knowledge, only five cases have been reported in the literature to date and there has been no reported case following closed intramedullary nailing for metastatic diaphyseal fracture of an ipsilateral long bone. We present a very unusual case of gastric cancer, which metastasized to all fingertips of the ipsilateral hand after closed interlocking intramedullary nailing of a pathologic fracture of the humerus.
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Affiliation(s)
- Won-Jong Bahk
- The Musculoskeletal Oncology Group, The Catholic University of Korea, Seoul, South Korea
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Hayden RJ, Sullivan LG, Jebson PJL. The hand in metastatic disease and acral manifestations of paraneoplastic syndromes. Hand Clin 2004; 20:335-43, vii. [PMID: 15275692 DOI: 10.1016/j.hcl.2004.03.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Metastatic tumors to the hand and wrist are rare, accounting for approximately 0.1% of all metastatic lesions to the skeleton. The biochemically mediated pathways of bone metastases, the location of the hand at the distal extremity, and the small amount of marrow in the bones of the hand and wrist account for the low prevalence of acrometastases. More rarely, hand dermatologic and soft tissue changes of paraneoplastic syndromes herald an occult malignancy.
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Affiliation(s)
- Radford J Hayden
- Division of Hand, Elbow, and Microsurgery, Department of Orthopaedic Surgery, University of Michigan Medical Center, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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