Hand metastasis in a patient with cervical cancer

Abstract

Introduction: Acrometastasis is infrequent and generally indicates a wider spread of metastasis with poor prognosis. The diagnosis is challenging, as it might mimic an infectious, inflammatory, or metabolic disease. Acrometastasis are most commonly found in patients with lung, gastrointestinal, kidney, and breast cancer. Only 3 cases of cervical cancer associated with hand metastasis have been reported in the literature. Patient concerns: Herein, we report a 58-year-old patient with locally advanced cervical cancer and recurrence in the right thumb as presentation of widespread disseminated disease. She initially presented with adenocarcinoma of the uterine cervix and was treated with concurrent chemoradiation followed by high-dose rate brachytherapy. Six months later, she developed an insidious onset of pain and swelling in the right thumb, erythema, and edema, mimicking cellulitis. Diagnosis: A biopsy of the soft tissues of the thumb was performed, and the histopathology indicated metastasis of adenocarcinoma to the bone and soft tissues. Interventions and outcomes: The patient rejected further treatment and died of progressive disease 4 months after the diagnosis of the recurrence. Conclusion: Metastases in unusual sites are a diagnostic challenge, and there is no standardized treatment. Timely diagnosis and treatment can improve the prognosis of these patients and might preserve their quality of life.

Mistaking a Tumour for an Infection - Acrometastasis of the Finger from Endocervical Adenosquamous Carcinoma: A Case Report

“…Although we knew that amputation was the solution, however we were debating on performing a proximal interphalangeal joint level amputation (for an infection) versus a Ray amputation (for a malignant tumour) causing another delay. Other differential diagnoses that need to be excluded are felon, gout, osteomyelitis, rheumatoid arthritis, pyogenic granuloma, tuberculosis and primary skin tumours 1 , 4 .…”

“…Acrometastasis is defined as metastasis distal to the elbow and knee. It has a rare occurrence with only 0.1% of cases reported 1 - 4 . The most common sites for the primary tumours are namely – lung, colorectal, breast and genitourinary.…”

“…The most common sites for the primary tumours are namely – lung, colorectal, breast and genitourinary. Acrometastasis from endocervical adenosquamous carcinoma is extremely uncommon 4 . Though rare, they are an indicator of poor prognosis, and survival has been reported to be only up to seven months from diagnosis 1 , 3 , 4 .…”

“…Acrometastasis from endocervical adenosquamous carcinoma is extremely uncommon 4 . Though rare, they are an indicator of poor prognosis, and survival has been reported to be only up to seven months from diagnosis 1 , 3 , 4 . They can present as a subtle swelling, with or without pain and sometimes they present as an infection to the fingers following trivial trauma.…”

“…A high index of suspicion should be present when the patient has a known history of malignancy. Despite that, acrometastasis could be a terminal presentation of an undiagnosed primary malignancy 1 - 4 . An accurate history, clinical examination and adequate imaging are needed to diagnose acrometastasis.…”