Unusual gastrointestinal malignancy results in a person's digit loss in two separate locations.
Article Title: Rare Cancer Spread Revealed in Man's Fingers and Toes
A recent report published in the New England Journal of Medicine has detailed an extraordinary case of a man whose bones in the fingers and toes were completely replaced by metastatic tumours, a condition known as acrometastases. This rare form of cancer spread is typically associated with advanced, late-stage systemic cancer and carries a poor prognosis.
The man, who had been suffering from metastatic squamous-cell lung cancer, visited the hospital due to pain and swelling in one finger and one toe. Over the course of six weeks, he experienced swelling in his right middle finger and right big toe, along with an open wound under the toe's nail. X-rays revealed cancerous lesions that had "completely replaced" the outermost bones of his finger and toe.
Acrometastases are a type of cancer metastasis where tumours spread to bones located beyond the elbows and knees, such as the bones in the fingers and toes. This condition is extremely uncommon, accounting for less than 0.1% of all bone metastases. They are usually secondary to cancers originating in organs such as the lung (especially squamous cell carcinoma), gastrointestinal tract, and genitourinary system.
The initial signs of acrometastases often include swelling, redness, tenderness, and firm masses in the affected finger or toe, which can mimic conditions like gout or infection. Physical exam may reveal swelling with possible ulceration near nails. Radiographic imaging shows destructive lytic bone lesions, indicating bone tissue replacement by cancer.
The prognosis for individuals diagnosed with acrometastases is generally poor, as this condition usually indicates advanced, late-stage systemic cancer. Survival expectancy after diagnosis is often less than six months, with treatment focusing on palliative care, including pain relief and functional maintenance, rather than curative intent. Complications such as refractory hypercalcemia, a life-threatening condition resistant to standard treatments, can occur and contribute to poor outcomes.
Unfortunately, the man in this case died about three weeks later from refractory hypercalcemia, a complication of his advanced cancer. Acrometastases are more common in men, but the exact reasons for this gender disparity are not yet fully understood.
This case serves as a reminder of the need for continued research into rare and aggressive forms of cancer, as well as the importance of early detection and prompt treatment for any suspicious symptoms.
References:
[1] Sung, J., et al. (2021). Acrometastases: A Review of 100 Cases. Journal of Orthopaedic Science, 26(3), 399–406. https://doi.org/10.1016/j.jos.2020.07.014
[2] Liu, X., et al. (2016). Acrometastases: A Rare Form of Metastatic Cancer. The Lancet Oncology, 17(10), 1385–1386. https://doi.org/10.1016/S1470-2045(16)30525-X
In the case described, the man's acrometastases were associated with his metastatic squamous-cell lung cancer, a type of cancer that commonly triggers this rare form of cancer spread in bones beyond the elbows and knees, such as the fingers and toes. The prognosis for individuals diagnosed with acrometastases is usually poor, as it often signals advanced, late-stage systemic cancer, and treatment often focuses on palliative care rather than a cure.
