Journal of Clinical Oncology, Vol 21, Issue 13
(July), 2003: 2620
© 2003 American Society for Clinical Oncology
Some Unusual Paraneoplastic Syndromes
CASE 1. METASTATIC SQUAMOUS CELL ESOPHAGEAL CANCER TO THE THUMB
David Aguiar Bujanda,
Uriel Bohn Sarmiento,
Jose Aguiar Morales
Servicio de Oncologia Medica, Hospital de Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
A 56-year-old white male was received in our outpatient clinic because of slight pain and swelling on the thumb of his left hand. The patient reported a history of trauma with a fishhook 3 days earlier but recognized that the finger was already swollen for a week. The symptoms were confined to the distal phalanx of the thumb, and on examination, it had an inflammatory aspect (Fig 1 ). He had been diagnosed 3 months earlier with squamous cell esophageal carcinoma with metastatic supraclavicular lymph nodes. He was treated with palliative radiotherapy and cisplatin-fluorouracil chemotherapy. A complete regression of the supraclavicular nodes and a resolution of the dysphagia were obtained.
A radiograph of the thumb (Fig 2) showed destruction of the distal phalanx with soft-tissue tumor and lytic lesions in the proximal phalanx. A biopsy was performed, revealing metastatic squamous cell carcinoma. Recurrence of the esophageal tumor was detected by endoscopic examination, and it was the only evidence of disease relapse after work-up. The pain was controlled with nonsteroidal analgesics, but the patient developed recurrent dysphagia and started second-line chemotherapy.
View larger version (91K):
[in this window]
[in a new window]
|
Fig 2. A radiograph of the thumb showing destruction of the distal phalanx with soft-tissue tumor and lytic lesions in the proximal phalanx.
|
|
Bone metastases are frequent in cancer patients; however, acrometastases or metastases to the hand and foot are rare. Acrometastases have been reported in a variety of malignancies, such as breast, lung, gastrointestinal, and genitourinary tract, especially renal cell carcinoma.1 In some cases, it can be the first manifestation of an occult cancer.2,3 A biopsy must be performed to confirm the diagnosis because many cases are often mistaken for benign processes, such as infection or inflammatory arthritis.
EDITOR’S NOTE
See also "Acrometastasis as an Initial Presentation of Non–Small-Cell Lung Carcinoma" Jänne P, et al: J Clin Oncol 17:2998–3001, 1999.
REFERENCES
1. Troncoso A, Ro JY, Grignon DJ, et al: Renal cell carcinoma with acrometastasis: Report of two cases and review of the literature. Mod Pathol 4:66–69, 1991[Medline]
2. Janne PA, Datta MW, Johnson BE: Lung cancer presenting with solitary bone metastases. Case 2: Acrometastasis as an initial presentation of non–small-cell lung carcinoma. J Clin Oncol 17:2998–3001, 1999[Free Full Text]
3. Healey JH, Turnbull AD, Miedema B, et al: Acrometastases: A study of twenty-nine patients with osseous involvement of the hands and feet. J Bone Joint Surg Am 68:743–746, 1986[Abstract/Free Full Text]
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
|
