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Write a review Rate this item: 1 2 3 4 5. Preview this item Preview this item. Subjects Medicine. Biomedicine View all subjects More like this Similar Items. Find a copy online Links to this item doi. Allow this favorite library to be seen by others Keep this favorite library private. Find a copy in the library Finding libraries that hold this item Reviews User-contributed reviews Add a review and share your thoughts with other readers.
Be the first. Add a review and share your thoughts with other readers. Similar Items Related Subjects: 7 Medicine. Biomedicine Cancer -- Research. Cancer -- Research Medicine Oncology. Metastases to the carpal bones are much rarer than those to the metacarpal and phalangeal bones.
Lung Cancer Metastasis: Novel Biological Mechanisms and Impact on Clinical Practice / Edition 1
For this reason, a metastasis in the carpus is more often misdiagnosed. The described case regards a metastasis from severely undifferentiated large-cell lung carcinoma. Large cell carcinoma is classified among the non-small-cell lung carcinomas NSCLCs , which comprise a heterogeneous group of histology types, with the most frequent types being adenocarcinoma, squamous cell carcinoma, large cell carcinoma, adenosquamous carcinoma and sarcomatoid carcinoma.
The first physician based his diagnosis on clinical symptoms pain at motion of the left thumb, not at rest , probably waiting upon the results of his therapy. The combination of the clinical and radiological pictures could actually induce the suspicion of thumb osteoarthritis. The radiological picture of diffuse osteoporosis led the physician to think of a diffused disuse osteoporosis, caused by the severe pain.
When the patient presented to the third physician it was an emergency admission to an internal medicine department because progressive worsening of his general condition was evident as well as an enormous swelling of the left hand. The correct diagnosis would have been made sooner if the patient had presented at the requested follow-ups. An early diagnosis was not easy, but the first two physicians examining the patient might have been too superficial in their anamnesis, clinical examinations and X-ray interpretations. One more clue should have been the fact that the patient was a heavy cigarette smoker.
These facts should have made the two physicians suspicious. Moreover, the second physician underestimated the radiological signs of diffuse osteoporosis which were probably, in part, areas of osteolysis. It was probably not logical to imagine a malignant location on the basis of the data that arose from the first clinical examinations and X-rays.
The rarity of metastases to the distal regions of the limbs can induce a physician to suspect a primary tumor of the hand. They are rare, too, especially in the carpal bones.
When a metastasis to the hand is discovered, it is very probable that other previous metastases are disseminated in the skeleton, because metastases of hand bones generally indicate very advanced primary tumors. The hand as the first location of metastasis is the main peculiarity of the presented case. Metastases to the hand are rare, but those to the carpal bones are even rarer. The location of the lesion at the trapezium, as the first X-rays showed, led the examining physicians to suspect other disorders. The described case was not easy to diagnose because of the poor compliance of the patient and the rarity of carpal bone metastasis.
Written informed consent was obtained from the patient for the publication of this case report and its accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. GR operated on the patient and was a major contributor in writing the manuscript. AC interpreted the patient's histological data. RA collected all the data in the anamnesis of the patient, and contacted the colleagues from Oncology, Pathology and Chest Surgery, to receive a multidisciplinary opinion about the case.
All authors read and approved the final manuscript. National Center for Biotechnology Information , U. J Med Case Rep.
Published online Nov Author information Article notes Copyright and License information Disclaimer. Corresponding author. Giuseppe Rinonapoli: ti. Received Nov 1; Accepted Oct 3.
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This article has been cited by other articles in PMC. Abstract Introduction A first metastasis to the hand is extremely rare. Case presentation A year-old Caucasian man was submitted to several physical examinations for thumb pain. Conclusion Less than 20 case reports are available in the literature dealing with metastases to carpal bones. Case presentation A year-old Caucasian man, who was a regular drinker and heavy cigarette smoker, presented to a rheumatologist for pain at motion of his left thumb.
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Figure 4. Chest computed tomography scan revealing a mass in the superior left lobe arrow.
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Figure 5. Figure 6. Figure 7. Figure 8. Conclusion The described case was not easy to diagnose because of the poor compliance of the patient and the rarity of carpal bone metastasis. Consent Written informed consent was obtained from the patient for the publication of this case report and its accompanying images.
Competing interests The authors declare that they have no competing interests. Authors' contributions GR operated on the patient and was a major contributor in writing the manuscript. Incidence, location and diagnostic evaluation of metastatic bone disease.
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Orthop Clin North Am. Cancer Statistics. CA Cancer J Clin. The clinical course of bone metastases from breast cancer. Br J Cancer. Upper limb bone metastases. Tech Orthop. New York: Churchill Livingstone; Bone metastases; pp.