Talar metastasis of mucinous lung adenocarcinoma with fluid-fluid levels: a rare presentation mimicking a benign tumor.

The differential diagnosis of bone tumors in the talus is broad and includes both benign and malignant conditions. Metastases, although very rare, are one of these conditions. The typical nonspecific clinical and radiological presentations of metastases are a diagnostic challenge, and a high level of suspicion is needed in order to perform an adequate diagnostic approach. Moreover, they can present with features which have classically been associated with benign conditions such as fluid-fluid levels. We present a rare case of talar metastasis of a mucinous pulmonary adenocarcinoma that presented with fluid-fluid levels and was initially misdiagnosed as a giant-cell tumor with areas of secondary aneurysmal bone cyst transformation.

From the Breast to the Finger - A Case Report of Acrometastasis.

BACKGROUND: Acrometastasis is an unusual presentation that is associated with a poor prognosis. SUMMARY OF CASE: We report a case of an advanced breast cancer in a Nigerian woman, with clinical, radiological and histopathological features of lung, brain, and distal phalanx metastases. We report this case to highlight the need to have a high index of suspicion for acrometastasis as well as to emphasize the effect and challenges of managing metastatic breast cancer in a low-income country. CONCLUSION: Breast cancer metastasis to the bones of the hand is a rare condition and associated with poor prognosis.

CONTEXTE: L'acrométastase est une présentation inhabituelle associée à un pronostic défavorable. RÉSUMÉ DU CAS: Nous rapportons le cas d'un cancer du sein avancé chez une femme nigériane, présentant des caractéristiques cliniques, radiologiques et histopathologiques de métastases pulmonaires, cérébrales et de la phalange distale. Nous rapportons ce cas pour souligner la nécessité d'avoir un haut degré de suspicion pour l'acrométastase ainsi que pour souligner les effets et les défis de la prise en charge du cancer du sein métastatique dans un pays à faible revenu. CONCLUSION: La métastase du cancer du sein aux os de la main est une condition rare et associée à un pronostic défavorable. MOTS-CLÉS: Cancer du sein, Métastase, Acrométastase.

Unusual Manifestation of Chronic Lymphocytic Leukemia in the Hand.

Chronic lymphocytic leukemia (CLL) involving the hand, especially with bone involvement, is extremely rare. We report a case of a 62-year-old man, with a 4-year history of a subclinical CLL, presenting with chronic swelling and pain over the dorsal surface of the right hand, mimicking an infectious process. There was no clinical response to broad-spectrum antibiotics and topical corticosteroid therapy. Imaging was inconclusive. A tissue biopsy revealed a manifestation of the underlying leukemia. This case highlights the need to consider uncommon etiologies for atypical clinical presentations.

Talar Osteolytic Lesion as the Initial Presentation of Terminal Primary Metastatic Adenocarcinoma: A Case Report.

The purpose of this case report is to present an osseous foot lesion as the initial presentation of advanced metastatic adenocarcinoma. A 65-year-old female presented with 5 months of atraumatic left ankle pain. Initial radiographs and computed tomography scan showed a lytic lesion in the talar dome and calcaneus. Further workup and evaluation revealed diffuse metastatic disease in the lung, abdomen, and brain. A biopsy of the talar lesion demonstrated metastatic adenocarcinoma, and the patient elected to transition to hospice care less than 2 months after initial diagnosis. Although exceedingly rare, metastatic disease should be included in the differential for any lesion in the distal extremities including the foot and ankle. Unfortunately, these patients may have widespread metastases and poor prognosis at the time of initial presentation. This case report describes an acrometastasis of a primary adenocarcinoma and highlights the importance of considering metastatic disease in the differential of foot and ankle lesions. Delay in recognition and diagnosis of metastatic disease may have devastating consequences, and physicians could benefit from a high index of suspicion when treating these patients.

[Acrometastasis revealing a pulmonary adenocarcinoma: Report of a case with unusual histopathological findings]. / Acrométastase révélatrice d'un adénocarcinome pulmonaire : à propos d'un cas de présentation histopathologique inhabituelle.

Acrometastasis are rare and can be exceptionally indicative of an occult carcinoma. The prognosis is generally poor. The radiological and immunohistochemical findings can be of great value to determine the primary and to guide treatment. We report a case of a 56-years-old man with acrometastasis at the fourth finger of the left hand revealing a pulmonary adenocarcinoma. Histopathological analysis showed a cribriform adenocarcinoma with an unusual cytoplasmic co-expression of TTF1 and Hepar-1 upon immunohistochemical analysis. There was no nuclear TTF1 immunostaining. Imaging explorations showed a 6-cm mass of the left superior pulmonary lobe. The patient received immunochemotherapy. Upon follow-up, there was evidence of disease progression on chest computed tomography scan.

Bladder cancer presenting with acrometastases: a different cause of foot pain.

Acrometastasis means tumor seeding distally to the elbow or the knee and is an uncommon event. Foot acrometastases occur in 0.58% of patients with skeletal metastases overall, and only about 10% of these are caused by bladder cancer. We present a case of bladder cancer manifesting with insidious foot pain, caused by multiple lytic lesions located solely at the left foot. It was suspected after whole-body CT and later confirmed by biopsy result. We enumerate the differential diagnosis of distal extremity lytic lesions for educational purposes and review the literature listing similar published cases.

Metastatic Pulmonary Adenocarcinoma of the Talus: A Case Report.

Tumors rarely metastasize to the foot bones; however, a misdiagnosis can lead to a poor outcome. These metastatic tumors can cause foot pain and other symptoms in patients who are asymptomatic for the primary tumor. To accurately diagnose acrometastases, the attending physician must have a high index of suspicion and conduct a thorough examination and appropriate diagnostic testing. We present a rare case of metastatic pulmonary adenocarcinoma of the talus, which was initially misdiagnosed as a benign bone cyst. After pulmonary adenocarcinoma was diagnosed, the patient received multidrug treatment for the primary and metastatic lesions and was still responding well at the 12-month follow-up visit.

Metastases to the hand and wrist: an analysis of 221 cases.

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.

Index finger acrometastasis: A unique lung cancer case report.

INTRODUCTION AND IMPORTANCE: Hand metastases are notably rare, comprising around 0.1% of all metastatic diseases, mainly originating from lung cancer, which is responsible for 30-40% of such cases. This report highlights a rare occurrence of distal phalangeal metastasis in a patient with Lynch syndrome, underscoring the diagnostic challenges associated with hand metastases. CASE PRESENTATION: A 70-year-old male diagnosed with Lynch syndrome 35 years ago, following colon adenocarcinoma, presented with severe inflammatory lesions on his right index finger. Patient had previous liver segmentectomies to remove metastatic lesions and had multiple cutaneous squamous cell carcinomas in various regions. Recent diagnostics, including a chest CT, identified a thoracic mass suggestive of squamous cell lung carcinoma. Histopathological analysis confirmed the metastasis of lung cancer to the index finger, necessitating a transphalangeal amputation. CLINICAL DISCUSSION: Hand metastases are extremely infrequent, often mimicking other conditions and requiring a high index of suspicion for accurate diagnosis. This case reinforces the lung as a frequent origin of hand metastases and the significance of elevated EGFR expression in facilitating metastatic spread. CONCLUSION: The rarity of hand metastasis in patients with genetic predispositions like Lynch syndrome calls for heightened vigilance and an integrated management approach. It highlights the critical role of histopathology in diagnosis and the need to consider genetic factors in treatment planning. Further research is encouraged to understand the mechanisms enabling certain cancers to metastasize to the hand and the role of genetic conditions in these processes.

Pulmonary squamous cell carcinoma metastatic to the proximal interphalangeal joint of the right finger: report of a rare case and review of the literature.

Synovial metastasis is a rare condition with only a few cases reported in the literature. Synovial metastasis to the finger or toe joint is different from acrometastasis, which is defined as bone metastasis located distal to the elbow and knee. The most common site of synovial metastasis is the knee joint. Conversely, synovial metastasis to the finger or toe joints has, to our knowledge, been reported in one case only so far. Herein, we report the second case of synovial metastasis to the proximal interphalangeal joint of the right third finger in a patient with metastatic pulmonary squamous cell carcinoma and review the literature on synovial metastasis.

Metastatic Disease Mimicking Osteomyelitis in the Foot.

Cervical cancer most commonly spreads hematogenously to the lungs, liver, and bone. However, it rarely metastasizes to the foot. There is only one other case of cervical cancer with metastasis to the foot. In addition, the initial imaging of metastatic disease has difficulty in differentiating from infectious or other inflammatory processes, particularly in a clinical setting highly suspicious of infectious sources. Here, we present a rare case of cervical cancer metastasizing to the calcaneus masquerading as osteomyelitis, highlighting the importance of diagnostic imaging in conjunction with histological confirmation.

The Dog Bite, the Acrometastasis and the Disappearing Hamate.

In this case report, we describe a peculiar case of basaloid squamous cell carcinoma of the lung that was first diagnosed from a hamate metastasis. Acrometastases are bony metastases that are located distal to the elbow and knee. They generally become symptomatic only when a primary tumour has been identified. However, in this instance, the patient first sought medical attention following a dog bite to the ulnar side of the wrist, and thus the acrometastasis was diagnosed first, which is uncommon. We discuss the learning points relating to the unusual presentation of this case, classical acrometastatic features and a review of the literature.

Cancer Metastases to the Hand: A Systematic Review and Meta-analysis.

BACKGROUND: Metastatic lesions to the hand or wrist are rare and can mimic inflammatory and benign processes such as gout and infections. This often leads to misdiagnosis, underreporting, and delays in treatment. The purpose of this study was to examine all known cases of metastasis to the hand or wrist available in the literature and to analyze demographic trends, metastasis characteristics, and clinical course, and provide recommendations for management. METHODS: An online systematic review of MEDLINE, Embase, PubMed, and the Cochrane Library from inception to January 7, 2022, was completed. Studies outlining the care of a patient with acrometastases of the hand were included. Data extracted included age, sex, site of primary tumor and metastasis, presence of other metastases, time from primary diagnosis to acrometastasis diagnosis, misdiagnosis, treatment, and survival. RESULTS: Between 1889 and present, 871 lesions were described in 676 patients who met the inclusion criteria. There was no predilection for hand dominance or site of previous trauma. The mean age among patients was 59.5 (1.5-91) years, and male sex was more common (64.6%). The most common primary cancer source was the lung (39.2%), followed by the kidney (10.8%). The distal phalanx was the most frequently cited tumor location (33.7%). Mean survival after diagnosis of acrometastasis was 6.3 months (0.25-50) ± 11.5 months. CONCLUSION: Acrometastasis remains an uncommon presentation of metastatic disease with poor prognosis. Treatment currently focuses on pain management and optimizing functional outcomes. Our review led to the development of 7 treatment recommendations when managing these patients.

Solitary acrometastasis of the phalanx as initial presentation of an oligometastatic Kirsten rat sarcoma viral oncogene homolog-mutated lung adenocarcinoma: a case report.

BACKGROUND: Acrometastasis is an uncommon finding in non-small cell lung cancer and is usually a sign of multimetastatic disease. Few case reports have suggested solitary digital metastasis as the single secondary lesion of oligometastatic non-small cell lung cancer. CASE PRESENTATION: This case report describes an unusual presentation of a Kirsten rat sarcoma viral oncogene homolog-mutated lung adenocarcinoma with a solitary bone metastasis in the fourth finger medial phalanx, which was also the first sign of the disease, in a 63-year-old Caucasian female patient. Digital surgical amputation was performed. After histopathological confirmation and radiological exclusion of other secondary lesions, chemoimmunotherapy in a first-line setting was initiated. A partial metabolic response in the primary lung lesion was observed after four cycles. Maintenance therapy is currently being continued. CONCLUSION: Solitary digital metastasis is a rare finding in non-small cell lung cancer. Further studies are needed to investigate the mechanisms behind this particular dissemination process.

Acrometastasis: The Tip of the Iceberg of Metastatic Disease from Thyroid Cancer. Two Cases Report.

Acrometastasis, especially in the hands and fingers, is a rare clinical condition resulting from primary cancers such as lung, breast, kidney, and, rarely, thyroid cancer. Acrometastasis tends to be the tip of the iceberg in patients with extensive systemic disease, which could be regional, pulmonary, skeletal, neurological, or all of them combined. Even though these tumors are clearly visible and symptomatic, the diagnosis is usually misleading because such distal metastatic disease is not thought of at first. In general, systemic treatments should be given to any patient presenting digital acrometastasis. We describe two cases of papillary thyroid carcinoma and digital acrometastasis as a sign of advanced disease.

An Unusual Cause of Digit Pain: Acrometastasis From Lung Adenocarcinoma.

Acrometastasis accounts for 0.1% of all cases of metastatic cancer, with the most common primary tumor being lung cancer. Since acrometastasis is extremely rare and it generally has a nonspecific clinical presentation, it provides a diagnostic dilemma. We present a case of a 70-year-old female with a painful swollen right index finger which was found to be a metastatic lesion from adenocarcinoma of the lung. The patient expired within one month of diagnosis due to complications from her rapidly progressive metastatic cancer.

Acrometastasis as a mimic of complex regional pain syndrome.

Introduction: Complex regional pain syndrome (CRPS) is characterized by chronic pain disproportional to any inciting event, and is associated with poor quality of life, and large clinical, healthcare, and societal costs. A CRPS diagnosis is challenging due to the lack of biomarkers and objective laboratory and radiographic tests. CRPS is currently diagnosed according to the IASP clinical diagnostic criteria, and it is not a radiological diagnosis. We report a case of acrometastasis to the hand that was initially thought to be CRPS. The purpose of this publication is to reinforce the importance of CRPS to be a diagnosis of exclusion. Case presentation: A woman in her 70s presented to a primary care facility with moderate pain in the dorsum of her right wrist and hand that began approximately two weeks prior without trauma. The initial reading of the white blood cell scan and three-phase bone scan (TPBS) were suggested to be compatible with CRPS; however, a pain medicine specialist did not confirm the diagnosis. The patient was later diagnosed with acrometastasis as a result of a bone biopsy demonstrating metastatic lung adenocarcinoma. Conclusion: CRPS shares clinical indications with various inflammatory diseases. Imaging techniques cannot be solely utilized to diagnose CRPS due to nonuniform findings and not only low but varying sensitivity and specificity. The WBC scan, laboratory results, and the three-phase bone scan did not properly demonstrate CRPS. Our case demonstrates the importance of excluding all conditions with similar presentations prior to determining a CRPS diagnosis and understanding the importance of interpreting a TPBS.

Toe Acrometastasis as an Initial Sign of Metastasis in a Patient With a Large Cell Lung Carcinoma.

Acrometastases are rare lesions that originate most commonly from the primary lung cancer. They can mislead the diagnosis and the treatment, since they often appear as an osteomyelitis of the affected area. The presence of these metastases is a sign of poor prognosis, with a life expectancy of few months. We report a case of a 78-year-old male with an acrometastasis to the distal phalanx of the right fourth toe. It was the first sign that his previously diagnosed large cell lung carcinoma had reached a metastatic stage. Amputation of the toe was considered in this case where the intense pain of his acrometastasis could not be managed even with strong analgesics.

Swollen Finger - An Atypical Place for a Metastatic Lesion.

Acrometastasis, referring to metastases located distal to the elbow and knee, is a rare observation. The most common primary cancer site is the lungs, followed by colorectal, breast and genitourinary tract locations. We present a case of a 54-year-old woman with a 25-pack-year smoking history, chronic obstructive pulmonary disease and squamous cell carcinoma of the lung diagnosed at age 50. Upon physical examination, in the distal phalanx of the fourth finger of the right hand, there was a hypervascularized swelling, purplish and painful. Distal amputation of the fourth finger was performed with pathological anatomy compatible with acrometastasis of primary squamous cell carcinoma of the lung. Clinicians should be aware of this type of metastasis because it is sometimes difficult to distinguish from tuberculous dactylitis and other types of osteomyelitis in patients with undiagnosed cancer. The presence of acrometastasis confers a poor prognosis. LEARNING POINTS: Acrometastasis is a rare presentation of bone metastases.The diagnosis of acrometastasis is a challenge, due to the large number of differential diagnoses and the difficulty in detecting them early.The presence of acrometastasis confers a poor prognosis.

Two Cases of Acrometastasis from Lung Cancer Revealed on 18F-FDG PET/CT.

We present 2 cases of acrometastases that manifest as the first signs of underlying lung cancer. The first case is 37 year-old-man misdiagnosed and treated as having a traumatic fracture at the left thumb. The second case is a 77 year-old-man who received treatment for soft tissue infection at left hand for 4 weeks. In both cases 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography demonstrated primary malignant lesions in the lungs consistent with primary lung cancer with acrometastases.