Metastatic Prostate Carcinoma to the Foot with Magnetic Resonance Imaging and Pathologic Correlation

Abstract

Metastases to the bones of the foot from prostate carcinomas are rare and usually are associated with diffuse metastatic disease. The authors encountered a patient who presented with prostate carcinoma metastases limited to the right foot. Magnetic resonance imaging correlation in this case demonstrated normal marrow signal in the surrounding bones of the foot and increased vascularity of the foot.

Metastases to Bones of the Foot

“…22 Prolonged survival of 20 months 8 to 5 years 26 has been reported after surgical removal of the metastasis and aggressive treatment of the primary lesion. Schwartz et al 8 support the idea that current advances in cancer therapy can prolong survival, and thus timely diagnosis of metastases may be helpful.…”

“…4 Based on cases reported in the literature, the age at presentation in men ranged from 48 to 80 years with an average of 65.3 years. [5][6][7][8][9][10] In women, the age ranged from 40 to 86 years with an average of 67.6 years. [11][12][13][14][15][16] Previously known malignant disease was present in half of the patients.…”

“…A metastatic lesion to the foot was diagnosed 3 years after treatment for endometrial carcinoma, 21 4 years after treatment of a primary rectal cancer, 9 and even at 15 years after treatment of prostatic carcinoma. 8 Metastases to the foot had a variable clinical presentation, depending on the location of the lesion. Such variability led to late presentation and was mostly seen when metastases affected the toes, where clinically these lesions were mistaken for felon, whitlow, acute paronychia, gout, rheumatoid arthritis, osteomyelitis, infected hematoma, or even an ingrown toe nail.…”

“…1,24 Metastases from prostatic carcinoma have a characteristic appearance where lesions are sclerotic with intact cortices. 8 Yadav et al 23 reported finding expansion and extensive destruction of the second metatarsal by a soft tissue mass that replaced the entire metatarsal. Also, in rare cases, involvement may be so extensive such that destruction may involve the hindfoot and metatarsals.…”

Treatment of Metastatic Prostate Adenocarcinoma to the Calcaneus

“…The foot and ankle is an uncommon region for the deposit of metastatic carcinoma; however, the development of metastatic cancer in the foot and ankle has been well described in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9). In the proper clinical setting, foot and ankle surgeons must maintain an index of suspicion for the possibility of metastatic disease presenting in the foot and ankle.…”