Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: A retrospective study

Acrometastasis of the Lower Limb Carries a Poorer Prognosis: A Retrospective Cohort Study

BackgroundBony metastasis distal to the knee is rare and often reported alongside metastasis distal to the elbow. We sought to provide empirical evidence of the epidemiology, presentation, and prognosis of lower limb acrometastasis, alongside investigation of the distribution of metastases present while lower limb acrometastases form.MethodsThis retrospective cohort study identified 44 radiologically confirmed cases of lower limb acrometastasis from a single region. Case note review facilitated the extraction of data relating to the stated aims. Patients were grouped by extent of metastasis at primary diagnosis. Mann-Whitney U test compared metastatic burden, and Kaplan-Meier analysis compared survival.ResultsProstate and breast carcinoma were the most commonly diagnosed primary tumors. Sixty-eight acrometastatic lesions were identified, of which 70% presented asymptomatically. Lower limb acrometastasis was associated with metastatic disease at a significantly greater number of sites than those presenting with metastasis proximal to the knee only (P = .007) and conveyed a significantly worse survival than metastasis proximal to the knee or nil metastasis (P < .001). Median survival from diagnosis of lower limb acrometastasis was 1.0 year.ConclusionLower limb acrometastasis is associated with a large metastatic burden and occurs in the terminal year of disease. Radiological identification of cases reveals a distinct cohort of acrometastatic lesions, more likely to present asymptomatically, and arises from alternate primary carcinomas than those in previous literature.Levels of Evidence:Level IV: Case series.

Uncovering Hidden Metastases at Unusual Site: Emphasizing the Role of 177Lu-PSMA Posttherapy Scan in Detecting Rare Foot Metastasis in mCRPC

ABSTRACT

Prostate cancer frequently metastasizes to bones; however, the detection of metastases can be challenging in rare locations. We present the case of a 76-year-old man with metastatic castration-resistant prostate cancer with lymph nodal and skeletal metastases who underwent 177Lu-prostate-specific membrane antigen (PSMA) therapy. Initial 18F-PSMA PET/CT scan acquired until the midthigh failed to identify metastases in the foot, but posttherapy 177Lu-PSMA scan revealed the presence of metastases in the navicular and cuboid bones of the right foot, which is a very rare finding. This case highlights the limitations of standard PSMA PET/CT acquisition protocol and incremental value of whole-body posttherapy scan.

Primary lymphoma of bone of the little finger: a case report and review of the literature

Primary lymphoma of bone (PLB) is a rare, malignant lymphoid proliferation within bone accounting for less than 3% of all malignant bone tumors. In this case report, a 61-year-old female with past medical history of gout presented with pain and swelling in her right little finger. Initial radiographs demonstrated periostitis and soft tissue swelling about the right little finger. She returned three months later with progressive pain. Subsequent MRI and repeat radiographs demonstrated near complete destruction of the right little finger middle phalanx and periostitis with marrow infiltration at the right long finger. Given the rapid progression of disease, the differential diagnosis consisted primarily of aggressive neoplastic processes. The little finger ray was amputated through the level of the metacarpophalangeal joint and histopathology demonstrated large neoplastic cells that stained positive with CD45, CD20, and PAX5, compatible with diffuse large B-cell lymphoma. A subsequent normal bone marrow aspiration and PET-CT demonstrated no additional sites of disease, thus excluding secondary lymphoma to bone. To the best of our knowledge, this is the first case report of polyostotic PLB involving the hand. PLB of the hands may be initially misdiagnosed due to its rarity and clinical presentation mimicking rheumatological disease. Clinical vigilance in concert with close imaging follow-up is required to make the diagnosis in a timely fashion. We also review the existing PLB hand literature which consists of five cases.

A rare presentation of lung squamous cell carcinoma metastasis to the distal phalanx of the little finger: a case report

Lung cancer is one of the most common malignant tumors worldwide. Early detection is the most important factor that affects the prognosis of lung cancer patients. The distal phalanx is a highly unusual metastatic site of lung cancer, and is often misdiagnosed, especially when accompanied by trauma. Herein, we present the case of a 68-year-old male patient who injured his right little finger. We hope this rare case will help clinicians to better diagnosis acral metastases of lung cancer to prolong patient survival.