A 55-year-old man’s swelling in his toes and fingers had an unexpectedly unusual cause. In a case report, doctors revealed that metastatic tumors had “completely replaced” some of his bones.
Australian doctors outlined the case in the New England Journal of Medicine earlier this month. The man sought medical help after suffering pain and swelling in one finger and one toe for several weeks. The symptoms were linked to an uncommon complication of his previously diagnosed metastatic squamous-cell lung cancer. Sadly, he passed away shortly thereafter.
The diagnosis turned out to be acrometastases, which is where cancer spreads from the lungs to the bones beyond the elbows and knees. These cases are extremely rare, occurring in only about 0.1% of instances where cancer spreads to the bones. While they can sometimes signal hidden late-stage cancer, they often follow other noticeable symptoms, like in this instance. This condition typically arises from cancers related to the lungs, gastrointestinal tract, or urinary tract, and it tends to be more frequent in men.
The report detailed that the man had suffered from painful swelling in his right middle finger and big toe for six weeks, with an open wound beneath the toenail. His swollen digits were firm and tender. Acrometastases can look similar to gout or osteomyelitis, as noted by the report’s authors. However, X-rays quickly showed the real issue: cancerous lesions had “completely replaced” the outer bones of his afflicted finger and toe.
Images of the man’s finger and toe can be found in a recent post from the NEJM.
Given that acrometastases typically indicate advanced cancer, survival odds are generally poor. Patients often have a life expectancy of less than six months after the diagnosis. In this instance, the doctors chose to provide palliative radiotherapy to manage the cancer symptoms rather than attempt to eliminate the cancer itself. Unfortunately, the man died approximately three weeks later due to refractory hypercalcemia, a severe condition characterized by high blood calcium levels that don’t respond to standard treatments. This condition often accompanies cancer as well.
