Trapezial Acrometastasis as the First Presentation of Occult Lung Cancer

Abstract

Case: Acrometastasis is extremely rare, accounting for 0.1% of all skeletal metastases. Metastases to the carpus are rarer still. This condition can be the first manifestation of an occult malignancy and generally indicates advanced disease. We present the case of a 53-year-old woman with acrometastasis of squamous cell lung cancer to the trapezium as the initial presentation of her malignancy. Conclusion: The presentation of acrometastasis can mimic infectious or inflammatory processes, leading to an erroneous diagnosis. Although exceptionally uncommon, it is important to consider as a differential diagnosis for a destructive hand lesion.

Occult Non-Small Cell Lung Cancer: An Underappreciated Disease

“…Occult lung cancer, defined as the presence of malignant tumor cells in bronchial washing or sputum but demonstrated no tumor evidence by imaging [ 1 , 2 ], often manifests as metastasis diseases [ 3 , 4 , 5 ] or other internal diseases such as stroke [ 6 , 7 , 8 , 9 ], venous thromboembolism [ 10 , 11 ] and dermatomyositis [ 12 ]. When these patients develop apparent non-cancer-related symptoms, the vast majority may have already progressed to an advanced stage.…”

“…Owing to the ambiguous TNM stage, the prognosis of this subgroup disease is still an enigma, and elucidation of prognostic indicators is therefore necessary to define high-risk patients who may derive benefit from more intensive care. Following extensive literature review, due to the low incidence (about 0.53%) [ 8 ] and lack of tumor evidence by imaging [ 1 , 2 ], the number of related researches is still modest, and most of them are case reports [ 3 , 4 , 5 , 7 , 8 , 9 , 11 ]. The lack of clinical data makes the natural course of occult NSCLC far from understood and the establishment of corresponding therapeutic strategies impossible, and it also compromises efforts to define prognostic factors for occult NSCLC.…”