Acrometastasis of the Hand - A Report of Two Cases and a Literature Review

惡性腫瘤合併手術轉移－案例報告及文獻回顧

謝綺瀅(Chi-Ying Hsieh) ； 張克中(Ke-Chung Chang) ； 林之昀(Chih-Yun Lin) ； 游彥辰(Yen-Chen Yu) ； 阮廷倫(Tyng-Luen Roan) ； 陳右昇(Yo-Shen Chen) ； 林佐武(Tsuo-Wu Lin)

《臺灣整形外科醫學會雜誌》 26卷2期 (2017/06) Pp. 232-237

摘要

Background: Lung and liver cancers were the first and second major causes of death, respectively. One of the most common metastatic sites is the bone, but acrometastases are still rare. Aim and Objectives: We present a case of lung cancer and a case of hepatocellular carcinoma (HCC) that both involved acrometastasis to provide awareness that acrometastasis may no longer be a rare occurrence. Materials and Methods: We provide two patients, one diagnosed with non-small cell lung cancer (NSCLC) and the other diagnosed with HCC, both of whom diagnosed with malignancy at a late stage. They did not recognize their hand anomalies and did not seek medical attention until pain or bleeding occurred. Due to the characteristics of the wound and the history of cancer, metastases were highly suspected while pathologic examination confirmed later. One patient underwent amputation of the metastatic digit; the other did not survive to have the surgery because death of metastases to the brain. Results: Once the acrometastasis were confirmed, mortality proceeded rather quickly; one patient died within 2 months and the other died within 2 weeks. Amputation of the metastatic digit did not have a significant impact on their survivals. Acrometastasis could be a sign of poor prognosis and often indicates distant or systemic metastasis. Conclusion: We have three conclusions. First, malignant acrometastasis present with widely varied clinical symptoms and are often unnoticed or confused with infection. As malignant tumors are the first major cause of death, malignancy should be always kept in mind. Second, symptoms in the hand can also be the first manifestation of malignant tumors in people with no prior history of cancer. Therefore, a cancer with metastasis to the digit should also be considered if the unhealed or unexplainable wound occurs. Third, the presence of acrometastasis indicate poor prognosis.

關鍵字

acrometastasis ； hand metastasis ； lung cancer ； hepatocellular carcinoma

並列摘要

背景：隨著醫藥進步，國人平均餘命增加，癌症為國人十大死因之首。惡性腫瘤合併手部轉移過去常認為是罕見之病例而文獻中多是零星的病例報告。然而，近幾年案例報告劇增，轉移至手部的原始惡性腫瘤也涵蓋各式各樣的腫瘤。目的及目標：藉由提供兩個惡性腫瘤轉移手部的案例，來回顧文獻，提高警覺性，此類病患可能已經不再是罕見。材料及方法：我們報告兩位晚期才診斷出肺癌及肝癌的患者，一位因為左大拇指有分泌物及疼痛而會診；一位因為被門夾到右小指血流不止而就醫。其初期表現皆不明顯或根本沒注意到，就醫後因為傷口特性加上癌症病史而高度懷疑癌症轉移，病人接受切片檢驗後也證實為癌症轉移。一位接受截指手術，兩個月後過世；一位來不及接受手術就因為腫瘤轉移至腦部腦出血死亡。結果：兩位病患都有癌症晚期病史，手部症狀分別發生在診斷之後三個月及半年，且都發生在末端指節，從發現轉移至手部到死亡分別是兩個月及兩週。其中一位接受截指手術，但即使做截指手術也無法延長期存活率。結論：希望藉這兩個病例提高對此種過去認為少見疾病之警覺性，另外，很多病患先前沒有癌症病史，而是由手部症狀進而發現罹患惡性腫瘤。因此，當病患有癌症史或是不清楚是否有癌症史，但手部病灶部位出現在不常見的地方，或受傷伴隨著非典型症狀，例如異常出血，要高度警覺將此鑑別診斷列入考量。惡性腫瘤合併手部轉移發生時常常代表預後非常不好。