Authors
A. DUBAIL (1), P. BALDIN (2), I. BORBATH (3), O. BARBIER (4), C. GALANT (5) / [1] Université Catholique de Louvain, Brussels, Belgium, anatomopathology, [2] Cliniques universitaires Saint-Luc, Brussels, Belgium, Pathology, [3] Cliniques universitaires Saint-Luc, Brussels, Belgium, Hepatology and gastroenterology , [4] Cliniques universitaires Saint-Luc, Brussels, Belgium, Orthopaedic Surgery , [5] Cliniques universitaires Saint-Luc, Brussels, Belgium, Pathology
- Background and objective A 65-year-old woman suffered from pain and tumefaction in the distal phalanx of the right middle finger. The patient was previously operated for a pancreatic head adenocarcinoma (4 years before) with metastases in the right lung and in a mediastinal lymph node. Clinically, an uncommon metastatic location in the finger was suspected. In this case report, we sought to describe a clinical-pathological finding of an acrometastasis and to review literature of this rare and atypical entity. - Material and methods The patient underwent surgery with amputation of the right middle finger. Then, the specimen was grossly and microscopically examined to confirm the hypothesis of a metastatic localization of the pancreatic adenocarcinoma. - Results The gross examination objectified a tumefaction of the finger’s soft tissue associated with focal hemorrhagic spots. The skin and the nail were both intact. Histopathological analysis showed a glandular proliferation composed of cribriform structures lined by a pseudostratified, atypical columnar epithelium admixed with nests of tumoral cells floating in large mucus lakes. Lymphovascular invasion, perineural invasion and tumoral osteolysis were noted. Tumor cells exhibited a strong cytoplasmic expression for cytokeratins 7, 19 and 20. - Conclusion Acrometastasis is a rare and atypical metastatic location. Carcinomas that metastasize in this site mostly come from the lung, breast or kidney, pancreatic origin is therefore uncommon. The amputation is performed when other therapeutic options fail (e.g. radiotherapy). Main differential diagnosis include arthritis and infection. The pathobiological mechanism is unclear but many hypothesis have been proposed. Acrometastasis occurs late in the course of the disease and is usually associated with advanced stages. In addition, literature shows that, after diagnosis, life expectancy of the patient is very short (around 6 months) and surgery is only performed for palliative reasons. Even if the occurrence of acrometastasis is rare, it is important to bear in mind this option. Authors and affiliations Angélique Dubail1, Pamela Baldin1, Ivan Borbath2, Olivier Barbier3, Christine Galant 1 1. Department of Pathology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 2. Department of Hepatology and gastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium. 3. Department of Orthopaedic surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
