Swollen Finger - An Atypical Place for a Metastatic Lesion

Abstract

Acrometastasis, referring to metastases located distal to the elbow and knee, is a rare observation. The most common primary cancer site is the lungs, followed by colorectal, breast and genitourinary tract locations. We present a case of a 54-year-old woman with a 25-pack-year smoking history, chronic obstructive pulmonary disease and squamous cell carcinoma of the lung diagnosed at age 50. Upon physical examination, in the distal phalanx of the fourth finger of the right hand, there was a hypervascularized swelling, purplish and painful. Distal amputation of the fourth finger was performed with pathological anatomy compatible with acrometastasis of primary squamous cell carcinoma of the lung. Clinicians should be aware of this type of metastasis because it is sometimes difficult to distinguish from tuberculous dactylitis and other types of osteomyelitis in patients with undiagnosed cancer. The presence of acrometastasis confers a poor prognosis.

Learning points: Acrometastasis is a rare presentation of bone metastases.The diagnosis of acrometastasis is a challenge, due to the large number of differential diagnoses and the difficulty in detecting them early.The presence of acrometastasis confers a poor prognosis.

Keywords: Acrometastasis; squamous cell carcinoma of the lung.

Figure 1

Swelling of the distal phalange of the right fourth finger, hypervascularized, painful

Figure 2

An x-ray of the right hand showed osteolysis of the distal phalange of the fourth finger