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• W2051504227 abstract "Hand metastasis represents between 0.007 and 0.2 % of all metastatic lesions [1, 2]. Renal cell carcinoma accounts for only 10–12 % [3, 4] of these infrequent lesions. Finger metastases are commonly misdiagnosed due to their low frequency and because they can resemble an infectious condition [5]. We report a case of renal clear cell carcinoma with distal phalangeal metastasis and review the related literature. This case highlights the need to consider acrometastasis in the differential diagnosis of digital lesions in patients with renal clear cell carcinoma.Case ReportA 53-year-old right-handed man was seen by his family physician for pain and swelling in right fifth finger after a minor trauma; he had a history of disseminated renal clear cell carcinoma (RCC) with radiation-resistant metastases in lung and fourth lumbar and was under combined treatment with sunitinib and everolimus. The initial diagnosis was an infection, which was unsuccessfully treated with NSAIDs, cloxacillin and topic antiseptics, observing a continued increase in the swelling and the development of ulcers and necrotic areas (Fig. 1).Fig. 1Clinical appearance of distal phalangeal metastasis of renal clear cell carcinoma. Swollen fifth finger with necrotic and fibrinous areas resembling an infectious processPlain radiographs of the right hand revealed a permeative osteolytic lesion in the distal phalanx of the right hand fifth finger with an ill-defined radiolucent mass. The cortex was thinned out and destroyed in places, but the adjacent joint surface was uninvolved and the remaining bones were unremarkable (Fig. 2). Serum levels of rheumatoid factor, uric acid, calcium, phosphate, and alkaline phosphatase were within normal limits, and puncture-aspiration samples were cultured without bacterial growth.Fig. 2Plain radiographs confirm the presence of an expansile, lytic lesion at the distal phalanx of the right fifth finger with diffuse cortical break. The radiologic appearance is consistent with metastasis or infectionSix weeks after the initial local symptoms, the patient was referred to our hand surgery unit for assessment. Metastatic involvement was strongly suspected and, because the finger was not viable, it was amputated through the proximal phalanx without previous biopsy. Specimen samples were sent for microbiologic and pathologic studies. The bacterial cultures were negative. Histopathological study revealed metastasis of renal clear cell carcinoma that caused distal phalanx destruction and partial skin ulceration. The features of the acrometastasis were similar to those of the primary tumor diagnosed 5 years earlier. The lesion was composed of multiple nodules of cells with clear cytoplasm, moderate nuclear atypia, poor vascular proliferation, and scant mitosis (2/10 high power fields). Surgical margins were negative (Fig. 3).Fig. 3Cross-section of proximal phalanx with metastasis of renal clear cell carcinoma causing proximal phalanx destruction and partial skin ulceration (a). Panoramic image of histological section of the lesion stained with hematoxylin and eosin (H and E) ( ...There was a good recovery from the amputation, with an improvement in the hand pain. However, new lesions were observed on the third right hand finger tip, facial skin, and lips within a few weeks post-surgery, and the patient died after 3 months due to respiratory failure related to metastatic lung disease." @default.
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• W2051504227 date "2016-09-13" @default.
• W2051504227 modified "2023-09-25" @default.
• W2051504227 title "Renal Clear Cell Carcinoma Acrometastasis. An Unusual Terminal Condition" @default.
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• W2051504227 doi "https://doi.org/10.1007/s12593-014-0127-5" @default.
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