Finger foot phalanx metastasis revealing occult pulmonary adenocarcinoma: A case report and review of the literature

Lorenzo Andreani, Paolo Domenico Parchi, Nicola Piolanti* and Michele Lisanti

Orthopedics and Tramatology I Department University of Pisa, Via Paradisa 2 Pisa Zip Code 56121 Tuscany, Italy.

*Corresponding author E-mail: nicpio@hotmail.it; Fax +39050996501, Mobile +393397566410

Accepted 11 April, 2013

Abstract

Even if the skeleton is the third preferential metastatic site after the liver and the lung, digital metastases are rare, even more as initial sign of lung adenocarcinoma. Usually finger metastases present with swelling, warmth and dull pain that becomes throbbing whit time. Because of the rarity of acrometastases, especially as the presenting lesion, they are often misdiagnosed as a benign condition. Amputation of the involved finger is by far the most frequent surgical methodology. Unfortunately, at this time, the primary tumor has invariably spread to diffusely involve other organs and usually patients' survival is only few months. Management should be targeted to patient’s comfort, prevention of infections, and maintenance of function. In this report we present a case of a 66-years old caucasian male in which initial sign of  a lung adenocarcinoma was metastasis to the fourth toe. The patient was affected by non-insulin dependent diabetes and had a 3-months history of “infection” in the fingernail. The lesion was managed for 8 weeks as a diabetic ulcer. Finger metastasis is associated with poor prognosis and, due to the scarcity of cases, no standard management protocol exists. Acrometastasis may be the first manifestation of an occult cancer; it is important to optimize care with a systematic approach in order to make a timely diagnosis and initiate a proper treatment.

Keyword: acrometastasys, lung adenocarcinoma, finger.