GÖKHAN KAYNAK, Enis YILDIRIM, Hüseyin BOTANLIOĞLU, Tahir ÖĞÜT

Isolated foot metastasis of squamous cell carcinoma of the lung: a rare location

Squamous cell carcinoma of the lung usually presents as a local rather than a metastatic disease. We present a 55-year-old male who was referred to the orthopedics and traumatology clinic for evaluation of pain and discomfort around the left ankle 2 months after diagnosis of locally advanced nonsmall cell (squamous cell) lung cancer. Physical examination revealed nonspecific pain and tenderness around the ankle. T2-weighted MR images showed lesions like a bone marrow edema around the talar head and neck. Whole body dynamic bone scan revealed a metastatic lesion only in the foot. The patient died 4 months after diagnosis of the metastasis. Early diagnosis of foot metastasis may be challenging and delays in diagnosis of up to 24 months have been reported. Foot metastases are usually associated with advanced metastatic disease and survival rates are poor. Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot in the elderly lung cancer patients. Palliative treatments such as pain relief medications should be chosen for patients with an expectancy of short survival whereas aggressive approaches may be applied for those with longer survival expectations.

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1. Nakashima Y. Metastases involving bone. In: Folpe AL, Inwards CY, editors. Bone and soft tissue pathology. 1st ed. Philadelphia: Saunders Elsevier; 2010. p. 446-53.

2. Johnston AD. Pathology of metastatic tumors in bone. Clin Orthop Relat Res 1970;73:8-32.

3. Healey JH, Turnbull AD, Miedema B, Lane JM. Acrometastases. A study of twenty-nine patients with osseous involvement of the hands and feet. J Bone Joint Surg Am 1986;68:743-6.

4. Abrahams TG. Occult malignancy presenting as metastatic disease to the hand and wrist. Skeletal Radiol 1995;24:135-7.

5. Libson E, Bloom RA, Husband JE, Stoker DJ. Metastatic tumours of bones of the hand and foot. A comparative review and report of 43 additional cases. Skeletal Radiol 1987;16:387-92.

6. Baran R, Tosti A. Metastatic carcinoma to the terminal phalanx of the big toe: report of two cases and review of the literature. J Am Acad Dermatol 1994;31:259-63.

7. Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin 2001;51:15- 36.

8. Strauss B, Weller CV. Bronchogenic carcinoma; a statistical analysis of two hundred ninety-six cases with necropsy as to relationships between cell types and age, sex, and metastasis. AMA Arch Pathol 1957;63:602-11.

9. Mountain CF, Lukeman JM, Hammar SP, Chamberlain DW, Coulson WF, Page DL, et al. Lung cancer classification: the relationship of disease extent and cell type to survival in a clinical trials population. J Surg Oncol 1987;35:147-56.

10. Hansen HH, Muggia FM. Staging of inoperable patients with bronchogenic carcinoma with special reference to bone marrow examination and peritoneoscopy. Cancer 1972;30:1395-401.

11. Bos GD, Esther RJ, Woll TS. Foot tumors: diagnosis and treatment. J Am Acad Orthop Surg 2002;10:259-70.

12. Zindrick MR, Young MP, Daley RJ, Light TR. Metastatic tumors of the foot: case report and literature review. Clin Orthop Relat Res 1982;170:219-25.

13. Hattrup SJ, Amadio PC, Sim FH, Lombardi RM. Metastatic tumors of the foot and ankle. Foot Ankle 1988;8:243-7.

14. Krishnamurthy GT, Tubis M, Hiss J, Blahd WH. Distribution pattern of metastatic bone disease. A need for total body skeletal image. JAMA 1977;237:2504-6.

15. Weidmann CE, Ganz PA. Multiple synchronous lesions of acral metastasis. West J Med 1984;140:451-6.

16. Maheshwari AV, Chiappetta G, Kugler CD, Pitcher JD Jr, Temple HT. Metastatic skeletal disease of the foot: case reports and literature review. Foot Ankle Int 2008;29:699- 710.

17. Wu KK, Guise ER. Metastatic tumors of the foot. South Med J 1978;71:807-12.

18. Berlin SJ. A laboratory review of 67,000 foot tumors and lesions. J Am Podiatry Assoc 1984;74:341-7.

19. Kouvaris JR, Kouloulias VE, Papacharalampous XN, Koutselini HA, Gennatas CS, Limouris GS, et al. Isolated talus metastasis from breast carcinoma: a case report and review of the literature. Onkologie 2005;28:141-3.

20. Richter D, Hahn MP, Bosse A, Dávid A, Muhr G. Isolated talus metastasis of an occult bronchial carcinoma--a rare cause for chronic foot disorders. [Article in German] Zentralbl Chir 1994;119:726-9. [Abstract]