Acrometastasis due to Lung Adenocarcinoma

Abstract

We are presenting a case of acrometastasis in a male patient with lung adenocarcinoma. Acrometastases accumulate for 0.1% of all metastatic bone lesions and can be the first manifestation of cancer in approximately 10% of cases. The main clinical manifestations are tenderness, intermittent pain, functional impairment, erythema, heat and swelling of the affected part. Lung cancer is the main primary malignancy which causes acrometastases. Although the lesions can be recognized in x-rays or CT scans, the gold standard for the diagnosis is MRI scan in which the full extension of the tumor can be evaluated.The diagnosis is usually confirmed by fine-needle biopsy of the affected bone. In the presence of acrometastases, prognosis is very poor and palliative treatment is usually recommended. This case shows that patients at risk for lung cancer should be screened intensively when they develop persistent digital symptoms.

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

“…Many different hypotheses have been advanced, like the hematopoietic dissemination or multiple repetitive microtraumas [ 5 ]. In some cases, the acrometastasis could be the first sign of the presence of neoplasia, but they are mostly seen in patients with an established diagnosis of cancer [ 6 ]. Their presence is usually a sign of a terminal stage cancer, thus divulgating a bad prognosis with a mean life expectancy of six months [ 2 ].…”

“…The clinical presentation of phalangeal metastasis is often mistaken with an osteomyelitis or a gouty arthritis, because of the erythema, pain, and swelling [ 7 ]. Other entities can also mimic an acrometastasis, such as ganglion cysts, acute paronychial infections, pyogenic granulomas, herpes zoster, tuberculous dactylitis, erysipelas, or some skin tumors, making the diagnosis quite challenging [ 2 , 6 ].…”

“…When they originate from the lungs, they are most commonly seen as a lytic lesion to the bone, and in extremely rare cases as blastic lesions [ 9 ]. Even if the lesions can be seen on radiographs and CT scans, the gold standard imaging technique for diagnosis is the MRI, since it can reveal the extension, shape, and consistency of the tumor [ 6 ].…”

Malignant Bone and Soft Tissue Lesions of the Foot

“…In fact, it would explain the higher prevalence of lung tumors because tumor cells have immediate access to the systemic circulation through the left atrium and ventricle. Symptoms include tenderness, pain, functional impairment, erythema, heat, and swelling [49]. Often, the primary tumor is unknown and the acrometastasis is the presenting symptom.…”