Lambe Gerard, Le Patricia, Clay Timothy D
Department of General Medicine, Rockingham General Hospital, Rockingham, Western Australia, Australia.
Department of Dermatology, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia.
BMJ Case Rep. 2014 Dec 22;2014:bcr2014208665. doi: 10.1136/bcr-2014-208665.
A 72-year-old man with metastatic squamous cell carcinoma of the lung presents with new lesions in the distal phalanx of right fifth finger (painful) and left great toe (painless due to long-standing peripheral neuropathy). Initially a complication of cytotoxic chemotherapy is considered and a dermatological opinion is requested. Enlargement of the lesions over the space of a week leads to plain X-ray, with findings of destruction of the distal phalanx of the involved digits confirming metastatic disease. Palliative radiotherapy is administered to decrease pain and reduce the likelihood of cutaneous and infectious complications. The patient died from systemic disease progression soon after finishing his radiotherapy. Digital metastasis (acrometastasis) should be considered by clinicians in the workup of patients with persistent digital symptoms, particularly in those with known cancer or those at high risk of cancer.
一名72岁的男性，患有肺转移性鳞状细胞癌，其右小指远端指骨（疼痛）和左拇趾（因长期周围神经病变而无痛）出现新病灶。最初考虑为细胞毒性化疗的并发症，并征求了皮肤科意见。病灶在一周内增大，遂进行了X线平片检查，结果显示受累手指远端指骨破坏，证实为转移性疾病。给予姑息性放疗以减轻疼痛并降低皮肤和感染并发症的可能性。患者在放疗结束后不久因全身疾病进展而死亡。临床医生在对持续存在手指症状的患者进行检查时，应考虑指骨转移（肢端转移），尤其是那些已知患有癌症或癌症高危患者。
