S o m e U n u s u a l P a r a n e o p l a s t i c S y n d r o m e s CASE 1. METASTATIC SQUAMOUS CELL ESOPHAGEAL CANCER TO THE THUMBA 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.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.
Coronary sinus defects refer to interatrial communications that lie out of the confines of the atrial septum and leads from left to right shunt through the ostium of the coronary sinus. When associated with persistent left superior vena cava (PLSVC), mild systemic desaturation may occur depending on the extent of unroofing of the coronary sinus. Isolated defects without PLSVC are rare. Three-dimensional echocardiographic and surgical images are presented.
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