Published online Apr 6, 2020. doi: 10.12998/wjcc.v8.i7.1287
Peer-review started: December 20, 2019
First decision: January 7, 2020
Revised: January 13, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: April 6, 2020
Metastatic tumors of the hand are very rare. They are usually late manifestations of massive advanced malignancies. However, a small portion of acrometastases are indications of occult primary cancer. Here, we report an extremely rare case in which a scaphoid bone lesion was the initial manifestation and was found to be a metastasis from gastroesophageal junction (GEJ) cancer.
A 57-year-old male patient presented with ongoing left wrist pain and swelling after trauma. He was initially misdiagnosed with infection of the scaphoid bone and treated with antibiotics and anti-inflammatory drugs. Further radiographic investigations showed a scaphoid pathological fracture, indicating a metastatic tumor derived from the GEJ and/or right lung malignancies. Gastroscopy failed to identify the pathology of the mass at the GEJ, which grew in an exophytic pattern. A lung puncture biopsy was not performed because the patient refused the procedure. To relieve his wrist pain and obtain a definite pathology, we resected the scaphoid lesion. Based on the clinical and pathological results, the patient was finally diagnosed with multiple metastases of advanced GEJ adenocarcinoma. He underwent chemotherapy and died 6 mo after his initial presentation.
Despite the rareness of the disease, orthopedic surgeons should consider the possibility of metastasis to the bones of the hand when patients complain of persistent and progressive pain in the hand.
Core tip: Hand metastasis is very rare, especially when it is the first sign of an occult primary malignancy. Here, we report a case of a scaphoid bone lesion that had metastasized from a gastroesophageal junction adenocarcinoma; the initial manifestation was persistent wrist pain and swelling. Due to its low incidence and the lack of specific symptoms, hand bone metastasis is easily misdiagnosed, leading to delayed treatment. A review of the literature provides a systematic understanding of the epidemiology, manifestations, diagnosis, treatment, and prognosis of metastatic carcinomas of the hand. Moreover, the early detection and diagnosis of hand metastasis are needed to improve patients’ quality of life and prolong their survival.