Three Years' Survival after Diagnosis of Finger Metastasis from End-Stage Lung Cancer

Abstract

The authors have indicated no significant interest with commercial supporters.T here are cases in the literature presenting digital skin metastasis from a primary cancer. The majority of primary foci are reported as being lung carcinomas (40%). 1,2 We present a patient having finger metastasis from end-stage squamous cell carcinoma of the lung that had already metastasized to the brain and liver. The unusual point about our case was 3 years' survival of the patient after detection of digital skin metastasis and amputation of the finger, which is a remarkable finding, compared to similar cases in the literature. Case ReportA 68-year-old woman presented to our clinic with rapid swelling of her fingertip that had occurred within the previous month. She mentioned that the lesion had begun as a painful, purple nodule at her nail bed and had progressed rapidly. Three months earlier, inoperable Stage IV, T 4 N 0 M 2 , low-differentiated squamous cell carcinoma of the right lung had been diagnosed, which had metastasized to the brain and liver. She had received chemotherapy and radiotherapy. Results of a physical examination showed a 3-cm hemorrhagic, vegetative mass that invaded the subungual and pulp regions of the third finger of the right hand (Figure 1).Results of a punch biopsy were consistent with a desmoplastic reaction of the carcinoma at the stroma. The tumor cells were found to be atypical epithelial cells having hyperchromatic nuclei, pleomorphism, prominent mitotic activity, and eosinophilic cytoplasm.These findings were consistent with a diagnosis of low-differentiated squamous cell carcinoma. We amputated the finger at the level between the proximal and middle phalanges and repaired the stump primarily. Pathologic examination of the specimen showed that the epidermal and the dermal layers were devoid of the pathology, whereas the deep dermis had been totally infiltrated by the tumor cells. These findings were consistent with a diagnosis of metastasis of low-differentiated squamous cell carcinoma of the lung (Figures 2-4). The surgical margins were clear of tumoral invasion. The patient had received radiotherapy and chemotherapy earlier and had been under the planned chemotherapy protocol at that time. No additional regimen specific for the finger metastasis was planned by the medical oncology personnel. The patient died from multiorgan failure 3 years later. DiscussionLung cancers metastasize primarily to the bones. 1,2 However, approximately 0.2% of lung carcinomas have been reported to metastasize to the hand, and digital skin is an extremely unusual site. 2 Lung tumors have been reported as being the most responsible primary origin (40%) for hand, skin, and bone metastases, followed by kidney and breast tumors. 3 The hand region has been reported as

Metástase cutânea rara de provável carcinoma basaloide de cólon simulando granuloma piogênico

“…Radiotherapy is effective in many cases and when there is bone destruction may result in secondary local calcification that may preserve some of the functionality of the affected finger. 3,6 In the present case, it was decided to opt for radiotherapy, since it was believed that radiotherapy could control local progression of the tumor and preserve the functionality of the finger; however, results were unsatisfactory. This paper emphasizes the importance of considering a suspicion of skin metastases when diagnosing lesions that affect the fingers or toes.…”

“…[2][3][4][5][6][7][8][9] When affecting the fingers, the distal phalanx of the third finger appears to be the site most commonly affected for reasons that remain to be clarified. [3][4][5][6][7][8] In the present case, the patient had a lytic lesion, with bone absorption affecting almost the entire distal phalanx; however, the affected finger was the fourth rather than the third finger. In addition, there was a skin lesion, albeit without bone involvement, on the fourth finger of the contralateral hand.…”