Spontaneous sacral fracture with associated acrometastasis of the hand
Open Access
- 25 October 2021
- journal article
- Published by Scientific Scholar in Surgical Neurology International
- Vol. 12, 534
- https://doi.org/10.25259/sni_917_2021
Abstract
Acrometastases, secondary tumors affecting oncological patients with systemic metastases, are associated with a poor prognosis. In rare cases, acrometastases may precede establishing the primary tumor diagnosis. A 72-year-old female heavy smoker presented with low back pain, and right lower extremity sciatica/radiculopathy. X-rays, CT, MR, and PET-CT scans documented primary lung cancer with multi-organ metastases and accompanying pathological fractures involving the sacrum (S1) and right 4th digit. She underwent a S1 laminectomy and amputation of the distal phalanx of the right fourth finger. The histological examination documented a poorly differentiated pulmonary adenocarcinoma infiltrating bone and soft tissues in the respective locations. The patient was treated with a course of systemic immunotherapy (i.e. pembrolizumab). At 6-month follow-up, the patient is doing well and can stand and walk without pain. Spontaneous sacral fractures may be readily misdiagnosed as osteoporotic and/or traumatic lesions. However, in this case, the additional simultaneous presence of a lytic finger lesion raised the suspicion that these were both metastatic tumors. Such acrometastases, as in this case attributed to a lung primary, may indeed involve the spine.This publication has 3 references indexed in Scilit:
- Acrometastases to the Hand: A Systematic ReviewMedicina, 2021
- Metastases to the Hand and Wrist: An Analysis of 221 CasesThe Journal of Hand Surgery, 2014
- The hand in metastatic disease and acral manifestations of paraneoplastic syndromesHand Clinics, 2004