Troncoso A, Ro J Y, Grignon D J, Han W S, Wexler H, von Eschenbach A, Ayala A G
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston.
Mod Pathol. 1991 Jan;4(1):66-9.
Metastases to the small bones of the hands and feet are rare. Although acrometastasis is usually a late manifestation of disseminated disease, it may be the primary manifestation of an occult carcinoma. Clinically it may be confused with benign disease and be treated improperly. We report two cases of renal cell carcinoma metastatic to the distal phalanx of a finger in Case 1 and the proximal phalanx of a toe in Case 2. The lesion was discovered following trauma in Case 1. In Case 2 there was no history of trauma. These acrometastases were the first evidence of metastatic disease in these two patients who had undergone a nephrectomy for Stage II renal cell carcinoma 2 yr and 1 yr prior to the development of acrometastases, respectively. Additional visceral metastases developed over the following months in Case 1, and the patient expired 7 mo after the discovery of the acrometastasis. In Case 2, the acrometastasis was the only site of metastases, and the patient is alive and well without evidence of disease as of the latest follow-up in January 1990. Review of the literature, including our cases, revealed 22 cases of renal cell carcinoma metastatic to the bones of the hand, nine cases to the bones of the foot, and three cases to the bones of both hand and foot. The clinical characteristics, pathogenetic mechanisms, and treatment are reviewed.
转移至手足小骨的情况较为罕见。尽管肢端转移通常是播散性疾病的晚期表现，但它也可能是隐匿性癌的首要表现。在临床上，它可能会与良性疾病相混淆并得到不恰当的治疗。我们报告了两例肾细胞癌转移的病例，病例1转移至手指末节指骨，病例2转移至足趾近节趾骨。病例1的病变是在创伤后发现的。病例2则无创伤史。这些肢端转移分别是这两名患者转移性疾病的首个证据，他们在肢端转移发生前2年和1年分别因II期肾细胞癌接受了肾切除术。病例1在接下来的几个月里出现了其他内脏转移，患者在肢端转移发现后7个月死亡。病例2中，肢端转移是唯一的转移部位，截至1990年1月的最新随访，该患者存活且情况良好，无疾病迹象。对包括我们病例在内的文献回顾显示，有22例肾细胞癌转移至手部骨骼，9例转移至足部骨骼，3例转移至手足骨骼。本文对其临床特征、发病机制及治疗进行了综述。
