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Valverde-Vilamala D, Sala-Pujals A, Cebamanos J, Dominguez-Font E. Acrometastases to the Hand and Wrist: A Series of 9 Cases and Review of the Literature. Revista Iberoamericana de Cirugía de la Mano 2022. [DOI: 10.1055/s-0042-1744260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction Acrometastases are extremely rare in the hand, with a prevalence of around 0.1% according to the literature. They are normally associated with advanced tumor stages, especially in lung cancer. The present article shows the experience of our center in the management and treatment of these pathologies.
Materials and Methods We report a series of 9 cases treated between 1992 and 2020 in the hand and wrist. Data regarding the primary tumor, the target organ, and survival are analyzed. A review of the cases of acrometastasis reported in the literature is also carried out, emphasizing in how many of then the acral lesion was the first sign of an unknown tumor.
Results Acrometastases predominantly affect male patients aged around 60 years, and the primary tumor that is the cause in most cases is lung cancer, with a very low survival rate after the diagnosis (of approximately 8 months).
Discussion and Conclusions In cases of acral lesion of non-traumatic origin, acrometastases should be considered, especially in patients who have a known primary tumor. In the present series, there were three cases in which the acrometastases were the first sign of a tumor in the patient, and in one of them it was initially treated as whitlow. In the literature, in approximately 50% of the cases, acrometastases are the first sign of the presence of a tumor.Once diagnosed, multidisciplinary medicosurgical treatment is essential to improve the patient's function and pain as much as possible.
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Umana GE, Scalia G, Palmisciano P, Passanisi M, Da Ros V, Pompili G, Barone F, Amico P, Tomasi SO, Graziano F, Patti IV, Mele S, Maugeri R, Raffa G, Giammalva GR, Iacopino GD, Germanò A, Nicoletti GF, Ippolito M, Sabini MG, Cicero S, Strigari L, Cuttone G. Acrometastases to the Hand: A Systematic Review. Medicina (Kaunas) 2021; 57:950. [PMID: 34577873 DOI: 10.3390/medicina57090950] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Falk DP, Scully R, Moss D, Shaffer M. Pathologic Tuft Fracture in a Thumb: A Rare Presentation of Metastatic Endometrioid Ovarian Carcinoma: A Case Report and Review of the Literature. JBJS Case Connect 2017; 7:e50. [PMID: 29252880 DOI: 10.2106/jbjs.cc.16.00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE A 51-year-old woman with a medical history noteworthy for endometrioid ovarian carcinoma presented with progressive left thumb swelling in the absence of trauma or injury. Radiographs revealed a lytic lesion in the distal phalanx. Inflammatory markers and white blood-cell count were mildly elevated. The thumb was amputated at the interphalangeal joint, and pathologic examination identified the lesion as an adenocarcinoma, consistent with the known endometrioid ovarian carcinoma. CONCLUSION The similar presentation of tumor and infection can present a diagnostic challenge. Despite the rare incidence of osseous metastases to the hand, orthopaedic surgeons must consider metastatic bone lesions in patients presenting with swollen or painful fingers.
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Affiliation(s)
- David P Falk
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - Ryan Scully
- Department of Orthopaedic Surgery, George Washington University Hospital, Washington, DC
| | - David Moss
- Department of Orthopaedic Surgery, George Washington University Medical Faculty Associates, Washington, DC
| | - Margaret Shaffer
- Department of Pathology, Sibley Memorial Hospital, Washington, DC
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Muñoz-mahamud E, Combalia A, Carreño A, Arandes J. Five cases of acrometastasis to the hand from a carcinoma and review of the literature. Hand Surgery and Rehabilitation 2017; 36:12-6. [DOI: 10.1016/j.hansur.2016.10.211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/03/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Kian Tjon Tan
- Royal Liverpool University Hospital Sarcoma Service, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Claire Simpson
- Royal Liverpool University Hospital Sarcoma Service, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Coonoor R. Chandrasekar
- Royal Liverpool University Hospital Sarcoma Service, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Abstract
A 46-year-old male was diagnosed of lung adenocarcinoma with right adrenal gland metastasis in January 2009, and underwent chemotherapy (DC (docetaxel and cisplatin) regimen) and stereotactic radiotherapy. In December 2009, whole brain radiotherapy was given to the patient due to brain metastasis. In January 2010, he complained of redness, swelling and tenderness of the fifth terminal phalange of his right hand. Open surgery and biopsy confirmed bone metastasis to the finger. The patient then received local injection of OK-432 combined with radiotherapy. The symptoms were greatly relieved after treatment and the patient has survived for 28 months at the time of this report.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Phalanx bone metastasis as the initial manifestation of lung cancer is a rare presentation. A 70-year-old man presented with swelling and pain in his right ring finger. He had no other complaints or abnormal findings on clinical examination. A right hand radiograph showed an osteolytic lesion in the first phalanx of the ring finger. Fine needle aspiration cytology of the swelling suggested a metastatic adenocarcinoma. A skeletal survey, hematological, biochemical, and other radiological tests were found to be normal, except for an opacity seen in the right lung midzone. A bronchoscopic biopsy revealed adenocarcinoma of the lung.
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Affiliation(s)
- Shankar L. Jakhar
- Department of Radiotherapy, Mathura Das Mathur Hospital, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - Rohitashwa Dana
- Department of Radiotherapy, Mathura Das Mathur Hospital, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
| | - D. P. Punia
- Department of Radiotherapy, Mathura Das Mathur Hospital, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, India
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Tzaveas A, Paraskevas G, Pazis I, Dimitriadis A, Kitsoulis P, Vrettakos A. Metastasis of bronchogenic carcinoma to the 5th metacarpal bone: a case report. Cases J 2008; 1:284. [PMID: 18973651 PMCID: PMC2590610 DOI: 10.1186/1757-1626-1-284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Accepted: 10/30/2008] [Indexed: 11/30/2022]
Abstract
Background Metastatic lesions to the hand are very rare and represent 0.1% of all osseous metastases. Case presentation We present a patient with metastasis of bronchogenic carcinoma of the lung to the 5th metacarpal to draw the attention for the potential of such lesions to be developed in this region. Due to the extensive metastasis to the hand the patient was referred to the oncologists. Conclusion The surgeon should be cautious regarding the differential diagnosis, the usual poor prognosis of such patients and the questionable need for reconstructive surgery.
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Affiliation(s)
- Alexandros Tzaveas
- Orthopaedic Department, B' IKA-ETAM "Panagia" Hospital, Thessaloniki, Greece.
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Park KH, Rho YH, Choi SJ, Hong SJ, Lee JH, Choi IK, Kim SJ, Seo JH, Choi CW, Kim BS, Shin SW, Kim YH, Song GG, Kim JS. Acute arthritis of carpal bones secondary to metastatic gastric cancer. Clin Rheumatol 2006; 25:258-61. [PMID: 16453079 DOI: 10.1007/s10067-005-1096-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Revised: 01/06/2005] [Accepted: 01/06/2005] [Indexed: 11/29/2022]
Abstract
A 39-year-old woman presented with acute onset of arthralgia in both wrists. Although her primary gastric cancer was in remission after previous treatment, carcinomatous arthritis was suggested by the osteolytic radiographic findings and refractoriness to nonsteroidal anti-inflammatory drugs, which was then confirmed by synovial fluid cytopathology. In view of the high incidence of gastric cancer in Korea, gastric cancer involving the carpal bones should be considered when we encounter a patient presenting with inflammatory peripheral joint arthritis, which might be the first sign of recurrence.
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Affiliation(s)
- Kyong-Hwa Park
- Division of Hematology-Oncology, Korea University Guro Hospital, 97 Guro-dong, Guro-gu, 152-703, Seoul, Korea
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Abstract
Solitary metastases to the small bones and/or to the soft tissue of the hands and feet (acrometastases) are rare. We report a case of renal cell carcinoma (RCC) with big toe metastasis revealed before the primary tumor became apparent. The best treatment for a single metastasis is always surgical excision, regardless of the lesion being synchronous or metachronous. The biological behavior of metastatic RCC is unpredictable and only early diagnosis and treatment may favorably affect patient survival. Thus, metastatic RCC should be included in the differential diagnosis of all enlarging cutaneous nodules, wherever they develop.
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Affiliation(s)
- Sisto Perdonà
- Department of Urology, National Cancer Institute, I.R.C.C.S. Fondazione 'G.Pascale', Naples, Italy.
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Affiliation(s)
- C Fusetti
- Division of Hand Surgery, Department of Orthopaedic, Plastic and Hand Surgery, University of Bern, Inselspital Bern, Bern, Switzerland
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Abstract
Metastatic tumors of the hand are rare, with fewer than 200 cases reported in the literature. Renal cell carcinoma is among the most common tumors to metastasize, but we are not aware of reports of this tumor metastasizing to the carpal bones. We describe a case of renal cell carcinoma that metastasized to the triquetrum to draw attention to the potential for such lesions developing within the hand and wrist.
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