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- Title
Spontaneous sacral fracture with associated acrometastasis of the hand.
- Authors
Umana, Giuseppe Emmanuele; Scalia, Gianluca; Palmisciano, Paolo; Passanisi, Maurizio; Pompili, Gianluca; Amico, Paolo; Ippolito, Massimo; Sabini, Maria Gabriella; Cicero, Salvatore; Perrotta, Rosario
- Abstract
Background: 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. Case Description: 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. Conclusion: 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.
- Subjects
SACRAL fractures; SPONTANEOUS fractures; PROGNOSIS; LUMBAR pain; FINGERS; METASTASIS
- Publication
Surgical Neurology International, 2021, Vol 12, p1
- ISSN
2229-5097
- Publication type
Article
- DOI
10.25259/SNI_917_2021