Acrometastases to the Hand: A Systematic Review

Abstract

Background and Objectives: The term acrometastases (AM) refers to secondary lesions sited distally to the elbow and knee, representing 0.1% of all bony metastases. By frequency, pulmonary cancer and gastrointestinal and genitourinary tract neoplasms are the most responsible for the reported AM. Improvements in oncologic patient care favor an increase in the incidence of such rare cases. We performed a systematic review of acrometastases to the hand to provide further insight into the management of these fragile patients. We also present a peculiar case of simultaneous acrometastasis to the ring finger and pathological vertebral fracture. Material and Methods: A literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement was conducted using the PubMed, Google Scholar, and Scopus databases in December 2020 on metastasis to the hand and wrist, from 1986 to 2020. MeSH terms included acrometastasis, carpal metastasis, hand metastasis, finger metastasis, phalangeal metastasis, and wrist metastasis. Results: In total, 215 studies reporting the follow-up of 247 patients were analyzed, with a median age of 62 years (range 10-91 years). Overall, 162 out of 247 patients were males (65.6%) and 85 were females (34.4%). The median reported follow-up was 5 months (range 0.5-39). The median time from primary tumor diagnosis to acrometastasis was 24 months (range 0.7-156). Acrometastases were located at the finger/phalanx (68.4%), carpal (14.2%), metacarpal (14.2%), or other sites (3.2%). The primary tumors were pulmonary in 91 patients (36.8%). The average interval from primary tumor diagnosis to acrometastasis varied according to the primary tumor type from 2 months (in patients with mesenchymal tumors) to 64.0 months (in patients with breast cancer). Conclusions: Acrometastases usually develop in the late stage of oncologic disease and are associated with short life expectancy. Their occurrence can no longer be considered rare; physicians should thus be updated on their surgical management and their impact on prognosis and survival.

Keywords: acrometastases; carcinoma; chemotherapy; immunotherapy; radiotherapy; thumb metastases.

Figure 1

PRISMA flow diagram regarding acrometastases to the hand.

Figure 2

The distribution of acrometastases’ localization against the primary tumor site.

Figure 3

Hand X-ray showing thickening of the soft tissue of the right ring finger’s distal phalanx, with fracture of the distal phalanx and moderate loss of bone substance.

Figure 4

Total-body 18F-FDG PET-CT scans showing accumulation of tracer in the fourth finger of the right hand (SUV max 18.3) (A) and middle and upper lobes of the right lung (SUV max 15.8) associated with 18-F-FDG uptake in the lymph nodes of the right axilla, prevascular, right paratracheal, at the Barety space, at precarenal, subcarinal, and hilum of the right lung (SUV max 16.6) (B). Additionally, tracer uptake at T7, T8, T10, L3, sacrum, right acetabulum, and ipsilateral ischiopubic branch is shown (C).