Ioia J V, Sumner J M, Gallagher T
Clin Orthop Relat Res. 1984 Sep(188):230-3.
Although peripheral metastases of many malignancies to bone are common, metastases to the hand and carpus are rare. This is the first report of a silent primary malignancy of the lung presenting as a metastasis to the carpal navicular bone. Only eight instances of carpal bone metastases secondary to all tumor sources were revealed in a search of the literature. The presentation of metastatic disease in the hand in an occult malignancy may be deceptive, often mimicking pulp space infection, osteomyelitis, septic arthritis, gout, acute rheumatoid monoarticular arthritis, tenosynovitis, or sympathetic dystrophy. These lesions often present as radiolucent lesions; histologic findings are consistent with the tumor of origin. Treatment is palliative and consists of resection or amputation. Radiotherapy should be avoided in the hand due to secondary fibrosis and scarring.
尽管许多恶性肿瘤发生骨转移很常见，但转移至手部和腕骨却很罕见。本文首次报道了一例隐匿性原发性肺癌转移至腕舟骨的病例。经文献检索，仅发现8例继发于各种肿瘤的腕骨转移病例。隐匿性恶性肿瘤累及手部时，转移性疾病的表现可能具有欺骗性，常酷似指髓间隙感染、骨髓炎、化脓性关节炎、痛风、急性类风湿性单关节炎、腱鞘炎或交感神经营养不良。这些病变通常表现为透射性病变；组织学检查结果与原发肿瘤一致。治疗以姑息治疗为主，包括切除或截肢。手部放疗应避免，以免导致继发性纤维化和瘢痕形成。
