Digital acrometastasis revealing endometrial cancer relapse

Abstract

Clinical Images: Digital acrometastasis revealing endometrial cancer relapseThe patient, a 68-year-old woman with a history of localized endometrial adenocarcinoma who had undergone hysterectomy followed by sequential chemotherapy and radiation therapy, was referred for evaluation of a painful mass on the second finger of the right hand (left). The mass had been insufficiently controlled by nonsteroidal antiinflammatory drug treatment and had rapidly increased in size during the preceding month. The patient had not experienced any trauma or fever, and acute gouty arthritis was suspected. Routine laboratory tests revealed negative blood cultures, moderate inflammatory syndrome (C-reactive protein 24 mg/liter), and normal levels of plasma uric acid. Plain radiography of the finger revealed osteoarthritis of the distal interphalangeal joint (DIJ) and a large soft tissue mass without calcification and no evidence of erosion of the phalanx (top right). Power Doppler ultrasonography of the finger (bottom right) (longitudinal view) showed a hypoechogenic solid hypervascular mass (blue Doppler signals) (arrows) in the soft tissue and surrounding the extensor tendon (asterisk), with no demonstrable involvement of the adjacent joints or bones. Histologic examination of a sample obtained by the ultrasound-guided biopsy revealed features of adenocarcinoma, compatible with digital acrometastasis (a rare site of carcinoma metastasis) of the endometrial cancer (1,2). The patient refused palliative amputation of the affected finger to relieve refractory cancer pain. A computed tomography scan showed multimetastatic dissemination to the liver, lung, and lumbar spine, leading to the patient's death 6 months after the presentation described here.

Mistaking a Tumour for an Infection - Acrometastasis of the Finger from Endocervical Adenosquamous Carcinoma: A Case Report

“…From our search, there have only been two cases reported in the English literature 1 . Sur et al 2 reported a case of acrometastasis from the uterus which, however, was a uterine leiomyosarcoma and Ornetti et al 5 presented another case which was not reported formally.…”