Palliative and supportive care in acrometastasis to the hand: Case series

Kumar, Narendra; Kumar, Ritesh; Bera, Anjan; Kumar, Pankaj; Angurana, Shabab; Ghosal, Sushmita; Srinivasan, Radhika; Sharma, Suresh C.

doi:10.4103/0973-1075.92347

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…Thus we had a final list of 90 articles for our analysis. [1112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100]…”

Section: Resultsmentioning

confidence: 99%

An exploratory analysis of levels of evidence for articles published in Indian journal of palliative care in the years 2010-2011

Kumar¹,

Sisodia²

2013

Indian J Palliat Care

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Context:Indian Journal of Palliative Care (IJPC) provides a comprehensive multidisciplinary evidence base for an evidence-informed clinical decision making.Aims:To analyze the levels of evidence of articles published in IJPC in the years 2010-2011.Settings and Design:Systematic review of palliative care journals.Materials and Methods:Systematic review of articles was done and was scored according to Center for Evidence-Based Medicine levels of evidence into any of the five grades. The articles were categorized based upon article type, number of authors, study approach, age focus, population focus, disease focus, goals of care, domains of care, models of care, and year of publication.Statistical Analysis Used:All descriptive analysis was done using frequencies and percentiles, and association between all categorical variables was done using Chi-square test at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc, Chicago, IL).Results:There was a greater prevalence of low level evidence (level 4: n = 46, 51%; level 5: n = 35, 39%) among the 90 selected articles, and article type (original articles with higher level of evidence, P = 0.000), article approach (analytical studies with higher level of evidence, P = 0.000), domains of palliative care (practice-related studies with higher level of evidence, P = 0.000) and models of care (biological or psychosocial model with higher level of evidence, P = 0.044) had a significant association with the grade of levels of evidence. Association with other factors was not statistically significant (P < 0.05).Conclusions:The levels of research evidence for palliative care provided by articles published in IJPC were predominantly level 4 and level 5, and there is scope for more high quality evidence to inform palliative care decisions in the developing countries.

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Section: Resultsmentioning

confidence: 99%

An exploratory analysis of levels of evidence for articles published in Indian journal of palliative care in the years 2010-2011

Kumar¹,

Sisodia²

2013

Indian J Palliat Care

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“…Acrometastasis often represents disseminated end-stage disease, and the patients consequently have a short life expectancy; the mean survival at the time of diagnosis is 7 months (range 3 to 18 months). [ 3 , 14 – 18 ] The average age at presentation is 61 ± 13 years, with a male:female ratio of 2:1. The distal phalanx is involved most frequently, and the thumb is the most common site of presentation.…”

Section: Discussionmentioning

confidence: 99%

“…The primary tumor sites of acrometastasis are the lung (40%), gastrointestinal tract (25%), kidney (11%–13%), and breast (11%–50%). [ 1 – 3 , 5 , 6 , 18 ] One report from 2004 showed only 3 cases related to cervical cancer (2%), and Afshar et al analyzed 221 cases of hand and wrist metastasis published over 27 years, of which uterine tumors accounted for only 2% (the study did not specify whether they were neoplasms of the endometrium or the cervix). [ 1 , 2 , 5 , 6 ]…”

Section: Discussionmentioning

confidence: 99%

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Hand metastasis in a patient with cervical cancer

et al. 2020

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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.

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“…Treatment is largely palliative because of the poor prognosis. 12,13 FIGURE 2 Pathology (hematoxylin and eosin stain) of a surgical specimen from a finger biopsy shows poorly differentiated small cell carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Digital acrometastasis: an unusual first presentation of an occult lung cancer

Ammannagari¹,

Chinnasamy²,

Laveaux³

et al. 2013

J Community Support Oncol

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A 57-year-old Caucasian man with a 32 pack-year history of smoking presented to the prime care clinic with a 2-week history of left index finger pain, redness, and swelling after sustaining a minor injury while closing his car door. Physical examination revealed a blackish discoloration of the skin. An X-ray of his left hand showed complete demineralization of the distal phalanx of the left index finger (Figure 1). The pain did not respond to NSAIDS, narcotics, and antibiotics. He subsequently underwent partial amputation of the finger. Pathology from the surgical specimen revealed a "poorly differentiated metastatic small-cell carcinoma" (Figure 2). He denied any dyspnea, cough, fever, night sweats, or loss of weight or appetite. The results of a computerized tomography scan of his thorax (Figure 3), abdomen, and pelvis revealed a large right lower lobe lung mass of 6.2 cm ϫ 4.2 cm adjacent to the right lower lobe bronchus that was consistent with lung cancer associated with pulmonary, hepatic, nodal, and skeletal metastasis. Magnetic resonance imaging of the brain showed multiple metastatic lesions throughout the brain, including the cerebellum. An MRI of the spine showed extensive metastatic lesions involving the thoracic vertebrae, T4-T12, and the lumbar vertebra, L2. Given the extensive metastases and poor prognosis, the patient chose hospice care and palliative services.

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Palliative and supportive care in acrometastasis to the hand: Case series

Cited by 11 publications

References 11 publications

An exploratory analysis of levels of evidence for articles published in Indian journal of palliative care in the years 2010-2011

An exploratory analysis of levels of evidence for articles published in Indian journal of palliative care in the years 2010-2011

Hand metastasis in a patient with cervical cancer

Digital acrometastasis: an unusual first presentation of an occult lung cancer

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