Acral Metastasis Research Articles

Cutaneous adenoid cystic carcinoma: clinical conundrum of a lower limb mass

BACKGROUND: Adenoid cystic carcinoma is a rare epithelial tumour of the salivary glands It arises even more rarely in the aerodigestive tract, lacrimal glands and adnexal skin glands. Acral metastasis is a rare presentation of carcinoma of unknown origin. Head and neck malignancies with acral metastasis are extremely rare. CASE REPORT: We present our case of metastatic adenoid cystic carcinoma presenting in the form of a tumour arising from an adnexal skin gland of the foot DISCUSSION: The case is an example of atypical presentation and dilemma in diagnosis of adenoid cystic carcinoma (histopathological confusion). To our knowledge there is no case in the literature with similar clinicopathological highlights CONCLUSION: Corroborative information is crucial for accurate diagnosis and appropriate management of patients by multidisciplinary teams. The need for timeous presentation and treatment for masses, even if clinically asymptomatic, is also highlighted Level of evidence: Level 5

Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: A retrospective study.

This study aimed to investigate the clinical, pathological, and prognostic characteristics of acral metastases in patients with malignant disease and to determine the impact of different types of acral metastasis treatment on patient survival. In this retrospective study, 64 acral metastatic lesions in 46 patients (17 women, 29 men; mean age, 61.5 years; age range, 35-82 years) who were evaluated by the Bone and Soft Tissue Tumors Council of our institute from 2015 to 2019 were included. The patients' primary tumor site, tumor type, localization of acral metastases, main symptom, duration from the diagnosis of the primary tumor to the diagnosis of acral metastasis, duration from the diagnosis of acral metastasis to death, and survival data were analyzed. The diagnosis of acral metastasis was confirmed by histopathological evaluation in 38 patients and clinical and radiological assessment of the lesions in 8 patients. The treatment type for each acral metastasis was individualized by the institutional Bone and Soft Tissue Tumors Council and categorized into 3 groups: excisional surgery (amputations and resections), palliative surgery (prophylactic fixation, intralesional curettage, and bone cement augmentation), and non-surgical treatment (chemotherapy, radiotherapy, and hormone therapy). A total of 16 acral metastases (25%) were identified in the upper extremity and 48 (75%) in the lower extremity. The most common primary tumor site was the lungs (32.6%), and the most common tumor type was adenocarcinoma (43.2%). The most frequent symptom and the primary reason for admission was pain (58.7%). The mean duration between the diagnosis of primary tumor and the diagnosis of acral metastasis was 19.1 (range, 0-124) months. No significant correlation was determined between the primary tumor types and duration from the diagnosis of primary tumor to the diagnosis of acral metastasis (p=0.278). Acral metastases were treated by excisional surgery in 15 (32.6%) patients, palliative surgery combined with non-surgical treatment in 10 (21.7%) patients, and only non-surgical treatment modalities in 21 (45.7%) patients. No significant correlation existed between the treatment types and patient survival (p=0.058). At the final follow-up, 30 (65.2%) patients were dead owing to the disease. The mean overall survival of the entire study group was 24.9 (range, 3-55) months. The mean duration between the diagnosis of acral metastasis and death was 7.6 (range, 3-24) months in patients who were dead owing to the disease (p=0.012). When the diagnosis of acral metastasis is established, it should be borne in mind that the most common primary tumor site and type are most likely the lungs and adenocarcinoma, respectively. The treatment type for acral metastasis may have no significant impact on patient survival, but the extensiveness of the disease may be a critical factor for survival. Level IV, Prognostic study.

Posttraumatic intraosseous epidermoid inclusion cyst. A case report and short literature review

Abstract Epidermoid bone inclusion cysts are pathological structures bordered by a layer of stratified squamous epithelium containing keratin debris. They are also called epidermal bone cysts. Intraosseous epidermoid cysts are rare entities; these lesions may occur as a result of trauma (puncture wound or pressure erosion). They appear to be well defined, translucent lytic lesions with sclerotic margins on imaging studies. The most frequent sites affected are: the distal phalanx and the calvaria - intradiploic, but a few cases of larger bone involvement have been reported. The imagistic differential diagnosis of this lesion includes intraosseous extension of a glomus tumor, enchondroma, osteoid osteoma, acral metastases, some primary vascular bone tumors, giant cell reparative granuloma, subungual nodular melanoma or other lytic non-neoplastic lesions such as osteomyelitis. We present the case of a 70-year-old man experiencing anxiety and pain due to distal phalanx expansion of the IV digit, following hand trauma. An X-ray was performed, showing a radiotransparent lesion located in the distal phalanx. An intramedullary inclusion cyst must be taken into account as a clinical differential diagnosis. Due to the extensive destruction of the distal phalanx, amputation was necessary. Gross examination of the surgical specimen revealed a cystic lesion that contained whitish, creamy material with extensive necrotic areas. Microscopic examination revealed a ruptured intraosseous epidermoid inclusion cyst, which was successfully excised.

Acral metastasis in carcinoma of buccal mucosa: An unusual presentation

Acral metastasis is rare in incidence with poor prognosis due to presence of widespread metastases during presentation. Lung is the most common primary for acral metastases followed by breast and kidney. Acrometastasis with head and neck primary is an extremely rare situation with only few cases reported in the literature. Here, we present a case of acral metastases in a 40-year-old male. The patient was previously diagnosed as a case of squamous cell carcinoma of gingivobuccal sulcus on the left side, and for which, he had undergone radical surgery followed by adjuvant concurrent chemoradiation 6 months back. The patient had local recurrence with multiple metastatic pleural nodules during diagnosis of acral metastasis. The patient was treated with one cycle of palliative chemotherapy followed by amputation of the metastatic finger. However, after 2 months of treatment, the patient was died due to the disease progression.

Acral Metastasis from Head and Neck Squamous Cell Carcinoma

Acral Metastasis from Head and Neck Squamous Cell Carcinoma

Lung Metastasis Mimicking Fingertip Infection.

Metastasis fingers (acral metastasis) are finding a poor prognosis. Past medical history should be questioned and metastasis from primary tumor should be kept in mind in patients with pain, swelling, and hyperemia in fingers. Successful surgical treatment on acral metastasis does not extend the life expectancy; however, it reduces the patient's pain during his terminal period, saves the functions of the limb, and increases life comfort.

Acral Metastasis in a Patient with Ampullary Carcinoma

Although Skin Metastasis From A Malignant Tumor Of An Internal Organ Usually Occurs At An Advanced Disease Stage, There Has Been No Prior Report Of A Cutaneous Acral Metastasis From Ampullary Carcinoma To Date. We Report A 71-year Old Male Patient With Cutaneous Metastasis From An Ampullary Adenocarcinoma. The Patient Had A History Of Pylorus Preserving Pancreaticoduodenectomy For Carcinoma Of The Ampulla Of Vater Two Years Prior To Presentation. Physical Examination Revealed Ill-defined, Painful And Hard Erythematous Nodules At The Left Thumb And Distal Phalanx Of The Right Middle Finger. The Computed Tomography Scan Showed Low Density Masses In The Retroperitoneum; The Histological Examination Of A Nodule From The Right Middle Finger Showed A Metastatic Adenocarcinoma. This Case Illustrates That Cutaneous Metastasis From Ampullary Carcinoma Has A Poor Prognosis.

Metástasis acral digital ósea por adenocarcinoma renal con afectación cutánea

Abstract—Cutaneous metastases are a rare and late manifestation of the internal malignancies. The likelihood of a visceral malignant tumour producing deposits in the skin is increased if the lesion is anaplastic and of long duration. Acral metastasis are specially atypical. Most acral metastases affect bones with late secondary cutaneous involvement.We report the case of a 67-years-old female with metastatic renal cell carcinoma who presented swelling and blue-reddish discoloration in the distal part of the 2nd finger of her left hand that had appeared four days before. On the hand X-ray there was a lytic lesion on the third phalanx of this finger. The histopathological findings showed a clear cell proliferation replacing deep dermis. A diagnosis of osseous metastases with late secondary skin involvement from renal cell carcinoma was made.

Cutaneous acral metastasis in a patient with primary gastric adenocarcinoma

Cutaneous acral metastasis in a patient with primary gastric adenocarcinoma