Digital Ischemia Associated With Cancer

Abstract

Digital ischemia associated with cancer (DIAC) is increasing in frequency and recent reports have suggested the concept of paraneoplastic manifestation. The aims of this study were to characterize the clinical presentation of DIAC and identify clinical features that could lead physicians to diagnose underlying cancer.From January 2004 to December 2011, 100 patients were hospitalized in the Department of Internal Medicine at Rouen University Hospital, France for a first episode of DI. Fifteen (15%) exhibited symptomatic or asymptomatic cancer during the year preceding or following vascular episode and constituted the DIAC group. Other patients without cancer made up the digital ischemia (DI) group.Median time between diagnosis of cancer and episode of digital necrosis was 2 months [0.25–9]. Diagnosis of DI and concomitant cancer was made in 7 of the 15 patients, while DI preceded the malignant disorder in 2 cases and followed it in 6 cases. Histological types were adenocarcinoma for 7 (46.7%), squamous cell carcinoma for 4 (26.7%), and lymphoid neoplasia for 3 patients (20%). Six patients (40%) had extensive cancer. Three patients were lost to follow-up and 5 patients died <1 year after diagnosis of cancer. Cancer treatment improved vascular symptoms in 6 patients (40%). Patients with DIAC, compared to patients with DI, were significantly older (56 years [33–79] vs 46 [17–83] P =0.005), and had significantly lower hemoglobin and hematocrit levels (12.7 g/dl vs 13.9 g/dl; P =0.003 and 38% vs 42%; P =0.003, respectively). Patients with DIAC had a higher platelet rate (420 vs 300 G/L P =0.01), and 6 patients with DIAC (40%) had thrombocytosis. There was no difference between groups either in C-reactive protein level (12 mg/L vs 5 mg/L; P =0.08) or regarding cardiovascular risk factors, presence of autoimmunity, or monoclonal protein.This retrospective study suggests that DIAC may be more prevalent than previously reported. Outcomes of the 2 diseases were not strictly chronologically parallel. However, in the majority of cases, treatment of the tumor resolved vascular involvement. Our findings suggest that age >50 years and thrombocytosis should alert physicians to consider a possible occult malignancy when digital necrosis occurs.

Out of the blue finger ischaemia and occult colorectal cancer

“…In a subsequent cohort study of 100 patients with a first episode of digital ischaemia, only 12 (12%) were diagnosed with cancer in the year preceding or following, and only 5 had adenocarcinoma 14. Raynaud's phenomenon (often unilateral) may precede digital ischaemia.…”

Digital Ischemia as an Unusual Manifestation of Hodgkin’s Lymphoma

“…Vasoconstrictive substances produced by the tumor cells, thromboembolic mechanism with embolization by microfragments of the tumor directly in the blood, circulating procoagulant factors, and impaired anticoagulant and fibrinolitic pathways are involved. Hyperstimulation of the sympathetic nervous system as a result of compression of the cervical plexus by the tumor and cryoglobulins of some cancer patients support the hypothesis of an immunologic mechanism [1, 2, 8, 9]. Outcomes of malignancy and digital ischemia may not be parallel.…”

“…Acral vascular syndromes may be encountered in various clinical conditions, such as connective tissue diseases, thromboembolic diseases, or atherosclerotic diseases and more rarely in malignancies [1, 2]. Among malignant disorders, solid tumors are the most frequently reported, mainly adenocarcinomas (lung, breast, and digestive), followed by hematooncological diseases, predominantly lymphoproliferative disorders [1–3].…”

“…Among malignant disorders, solid tumors are the most frequently reported, mainly adenocarcinomas (lung, breast, and digestive), followed by hematooncological diseases, predominantly lymphoproliferative disorders [1–3]. Acral vascular syndromes can occur concomitantly, precede or be diagnosed after cancer [2]. No differences in the clinical presentation of these syndromes have been mentioned depending on the underlying etiology.…”

Digital ischemia: Etiologies and long-term follow up. A cohort study of 323 patients

“…Past literature shows that only a few studies have focused on the prevalence of etiologies, in patients diagnosed with digital ischemia, with long-term clinical outcomes thus being rarely discussed. Only two retrospective studies about UEDI, with a cohort of over one hundred patients, were reported (2,4,5).…”