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Every few years, there is a case report in the literature of foot pain being either the presenting feature of cancer or occuring in those with known cancer somewhere else in the body (due to a metastasis). Recently, there have been two ..... providing a timely reminder of our importance in arriving at a correct diagnosis:
Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3 Isolated talus metastasis from breast carcinoma: a case report and review of the literature.
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Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
Another case report to serve as a timely reminder:
Isolated lower extremity metastases, 9 years after initial diagnosis of retinoblastoma.
Mulligan ME, Smith SE, McCarthy EF Jr.
Skeletal Radiol. 2005 Jun 7
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We report the development of isolated lower extremity metastases, in a child, 9 years after her initial diagnosis and treatment of bilateral infantile retinoblastomas. The radiographic, scintigraphic, computed tomographic, and magnetic resonance imaging findings are discussed. The dominant metastatic focus was blastic, involving the medial cuneiform. Additional occult lesions were found in the base of the second metatarsal, middle cuneiform, navicular and tibial diaphysis. An open biopsy confirmed the diagnosis
Here is two more: Occult carcinoma of the lung presenting as pain in the hallux: a case report.
J Foot Ankle Surg. 2005 Nov-Dec;44(6):483-6
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Metastatic tumors to the hands and feet (acrometastases) are rare. We report a case in which the primary presentation of a lung carcinoma was a metastatic lesion to the distal phalanx of the hallux. A 60-year-old woman was evaluated for pain in her big toe. Radiographs and computed tomography suggested a benign lesion in the distal phalanx of the hallux, but curettage and biopsy revealed metastatic adenocarcinoma. A chest x-ray revealed a mass in the right perihilar region, which was confirmed by CT, bronchoscopy, and biopsy as carcinoma of the lung. A review of the literature reveals that there is a tendency toward delayed diagnosis in similar cases, especially when the primary lesion is asymptomatic. A high index of suspicion is needed for early diagnosis in such cases.
Endometrial Carcinoma Metastasis to the Distal Phalanx of the Hallux: A Case Report
J Foot Ankle Surg. Volume 44, Issue 6, Pages 462-465
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Endometrial carcinoma is the most common invasive cancer of the female genital tract and accounts for 7% of all invasive cancer in women. Bony metastasis is uncommon with endometrial carcinoma and distal metastasis is very rare. The purpose of this paper is to present a case of an 86 year-old female with endometrial carcinoma metastasis to the distal phalanx of the hallux. The patient had a known history of endometrial carcinoma with metastases (FIGO IIIC), and had been diagnosed with pulmonary and bony metastases 2 months prior to presentation. Her initial foot complaint was of a painful, infected ingrown toenail. The infection continued to progress following avulsion of the nail, and the patient was then diagnosed with osteomyelitis. Given her past history, the possibility of metastasis to the hallux was also considered. A hallux amputation was performed, and the pathology report revealed the diagnosis of endometrial carcinoma metastasis to the distal phalanx of the hallux. While the amputation site healed uneventfully, the patient refused further treatment measures for her carcinoma and eventually succumbed to the disease.
This case is not axactly a metastasis, but again is a timely reminder re ddx's: Osteoid osteoma mimicking chronic arthritis. Diagnosis by bone scintigraphy. Hell J Nucl Med. 2005 Sep-Dec;8(3):171-3.
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The case of a patient with osteoid osteoma of the heel is presented. The patient was misdiagnosed and treated for four years as having arthritis. Osteoid osteoma was diagnosed by 99mTc-MDP bone scan that was performed for the evaluation of the arthritis. Plain radiography and magnetic resonance imaging (MRI) were negative for signs of arthritis. However, MRI when reevaluated after positive bone scintigraphy, was found positive for osteoid osteoma. This case underscores the value of bone scintigraphy for the diagnosis of osteoid osteoma.
Background: Gynecologic cancers metastatic to bone are rare. Endometrial carcinoma usually presents with vaginal bleeding. Case Report: A 67-year-old woman presented with pain, erythema and swelling of the right foot and no history of postmenopausal bleeding. Biopsy revealed primary endometrioid carcinoma metastatic to the calcaneus, talus and metatarsal bones. Lower leg amputation, total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node sampling were performed. Postoperatively the patient received cisplatin with adriamycin and megestrol acetate and is alive with no evidence of disease 20 months after the diagnosis. Conclusion: Endometrial carcinoma can present as a metastatic lesion of bone. Copyright (c) 2006 S. Karger AG, Basel.
The moral of this story:If it looks funny bioppy it!I had a lady recently with a reddish lesion on her great toe.I told her I was sending it out for a biopsy.Result:Benign.Still,a good clinical history is key.If there is any doubt,biopsy it or send for tests.The patients will not mind a bit.
One of our Pods sent a woman off for biopsy a couple of months ago - it was malignant and she's lost her toe, but it hasn't spread. (It was a melanoma)
Chondroma of the subcutaneous bursa of the achilles tendon.
Bull Hosp Jt Dis. 2005;63(1-2):24-6
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A 46-year-old female presented a six-month history of posterior heel pain. Clinical and radiographical examination revealed a nodular calcified mass into the subcutaneous tissue of the Achilles tendon bursa. Following excision, histopathology showed an extraskeletal soft-tissue chondroma. Follow up at 24 months showed no recurrence. To our knowledge, this is the first description of a soft tissue chondroma at this site: some soft tissue tumors develop at unusual anatomic location.
Statistically, metastasis of carcinomas to pedal phalanges is rare. However, true to all bone metastases of the body, its presence is associated with a very poor prognosis. A case of metastatic sinonasal squamous cell carcinoma to the fifth toe is presented followed by a review of the literature.
Metastatic involvement of a bone below the knee and elbow is rare. If it occurs it usually arises from primary tumours of the bronchus or pelvic organs, particularly the colon and the bladder. The case of a 58 years old male patient with recurrent transitional cell carcinoma of the bladder who presented with metastatic involvement of a metatarsal bone is presented. He presented with pain and swelling over the right foot. He was given antibiotic and there was no improvement, histopathological examination confirmed metastatic involvement of the metatarsal bone. To our knowledge, metastatic involvement of a bone below the knee has never been reported in Ethiopia.
Foot drop can be defined as a significant weakness in ankle and toe dorsiflexion. Injury to the dorsiflexors or to any point along the neural pathways that supply these muscles can result in a foot drop. Injury to the peroneal nerve is usually the major precipitant. Other causes vary from trauma to surgical nerve injury, as well as leg compartment syndromes or dorsiflexor injuries, peripheral nerve injuries, stroke, neuropathies, drug toxicities, spinal stenosis, L5 sciaticas, systemic diseases such as connective tissue diseases, vasculidities, or diabetes. This report focuses on a patient presenting with a foot drop as an unusual manifestation of brain metastasis. His minimal symptomatology seemed to point towards a local process. Therefore, early recognition and prompt treatment are essential. The central nervous system must be the target of investigations when the workup fails to disclose the proper etiology. Potential diagnostic delays may occur. Certain cases may require a more aggressive approach.
The Island Packet Online are reporting: Cancer goes down easier with Dr. Perfect and Jim Carrey
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To paraphrase Mark Twain, "The reports of my imminent demise are vastly exaggerated."
These rumors started when I was seen hanging out at the office of Dr. Gary Thomas, the oncologist. Somehow, people figured out I wasn't there for treatment of an ingrown toenail.
The odyssey began with a visit to the podiatrist because the soles of my feet were burning and my little happy toes were constantly moving. Feeling that a more serious ailment was in the works, he wisely recommended that I have my primary care physician arrange for blood work to be done. Noticing my decrepit footwear, he suggested that, meanwhile, I buy new sneakers and inner soles.
The next stop was the office of my Dr. Perfect Platt. He set up blood tests at a lab where they swiftly emptied out my veins, leaving me just enough blood to see me through the drive home. The merriment continued with a subsequent 24-hour analysis of, well, just say it wasn't the nectar of the gods. I was handed what looked like an 18-gallon jug and told to keep my jug contributions refrigerated. When I told my fair-weather friend, Carol Mueller, about my fridge's treasure, she said, "I'll never eat in your house again."....
Isolated foot drop due to a brain lesion is rare. A 48-year-old man complained of inability to dorsiflex the right foot. Right dorsiflexion had 0/5 muscle strength and there were no upper neuron findings on his neurological examination. Magnetic resonance imaging of the brain revealed a left parasagittal brain mass. The lesion was removed and muscle activity returned with 3/5 muscle strength 6 weeks after the operation. The parasagittal area is located at the foot of the homunculus. Therefore, in patients with foot drop, lesions of the parasagittal area should be considered.
Acrometastasis to the foot: an unusual presentation of transitional cell carcinoma of the bladder.
Khan S, Win Z, Lloyd CR, Neriman D, Szyszko TA, Svensson WE, Al-Nahhas A. Nucl Med Rev Cent East Eur. 2007;10(1):26-8.
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Metastases from bladder cancer to the bones of the hands or feet are rare and usually present after the diagnosis of the primary lesion has been made. This case report describes a 76-year-old man presenting with initial signs of infection of the right foot. Subsequent bone scan revealed multiple bony metastases and hydronephrosis raising the possibility of a primary bladder tumour that was later confirmed by urine cytology and fine needle aspiration of the foot.
OBJECTIVE: Common peroneal nerve (CPN) paresis or paralysis presents with weakness of the toe extensors as well as of the ankle dorsiflexors and evertors, causing foot drop and hypesthesia or paresthesia in the CPN distribution. Previous studies have shown associations with weight loss and leg crossing. Although CPN neuropathy has been described in cancer patients, it has not been described in head and neck cancer (HNC) patients specifically. Our objective was to describe a series of patients who developed CPN neuropathy during the course of their disease.
MATERIALS AND METHODS: A retrospective review of the charts of patients with HNC and CPN neuropathy who were seen at our institution between 1995 and 2004 was performed.
RESULTS: Four HNC patients with CPN neuropathy were identified. All had significant weight loss. One patient became symptomatic before treatment, 2 patients became symptomatic during treatment, and 1 patient developed foot drop 4 years after treatment when his free jejunal flap developed a stricture. Two patients had electrodiagnostic study findings that revealed conduction block at the fibular head and denervation of peroneal innervated muscles. Imaging studies revealed no evidence of metastatic disease in the lumbosacral region. All 4 patients improved after weight gain.
CONCLUSIONS: Common peroneal nerve neuropathy may be seen in HNC patients. The CPN may be susceptible in weight loss because of the associated loss of subcutaneous tissue, which cushions the nerve from the fibular head. Consideration should be given to prevention, appropriate neurologic consultation, and patient counseling.
Acrometastasis to the foot: an unusual presentation of transitional cell carcinoma of the bladder.
Khan S, Win Z, Lloyd CR, Neriman D, Szyszko TA, Svensson WE, Al-Nahhas A. Nucl Med Rev Cent East Eur. 2007;10(1):26-8.
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Metastases from bladder cancer to the bones of the hands or feet are rare and usually present after the diagnosis of the primary lesion has been made. This case report describes a 76-year-old man presenting with initial signs of infection of the right foot. Subsequent bone scan revealed multiple bony metastases and hydronephrosis raising the possibility of a primary bladder tumour that was later confirmed by urine cytology and fine needle aspiration of the foot.
Metastases to soft tissue: a review of 118 cases over a 30-year period.\
Plaza JA, Perez-Montiel D, Mayerson J, Morrison C, Suster S. Cancer. 2007 Nov 26; [Epub ahead of print]
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BACKGROUND.: Metastatic tumors presenting as soft tissue masses are relatively rare and can be the source of diagnostic confusion both clinically and pathologically. The authors' experience was reviewed at a large academic medical center over a 30-year period (1971-2000) with metastases to soft tissue.
METHODS.: The tumors in the study included mainly lesions involving skeletal muscle or skeletal muscle and subcutaneous tissue of the upper and lower limbs, trunk, shoulders, and buttocks. Direct extension from tumors originating in bone or adjacent organs, tumors involving the skin or areas known to contain abundant lymph nodes (ie, axilla, groin), and hematopoietic malignancies were excluded.
RESULTS.: One hundred and eighteen cases were identified; 60 patients were women and 58 were men. The age range was 20 to 87 years (median of 53.5 years). The primary tumor was located in the skin (19 patients), lung (13 patients), breast (13 patients), kidney (12 patients), colon and rectum (12 patients), uterus (8 patients), ovary (5 patients), head and neck (tongue, pharynx, larynx, nasal cavity, and mandible) (5 patients), esophagus (2 patients), stomach (2 patients), cervix (2 patients), small bowel (2 patients), bone (2 patients), adrenal gland (1 patient), eye (1 patient), testis (1 patient), urinary bladder (1 patient), and salivary gland (1 patient). In 27% (32 of 118 cases) of cases, the soft tissue metastasis was the initial manifestation of the disease. In 13.5% (16 of 118 cases) of cases the primary site of origin could not be identified. The sites of metastasis included the abdominal wall (25 patients), back, including scapular region (20 patients), thigh (17 patients), chest wall (15 patients), arm (15 patients), shoulder (11 patients), buttock (5 patients), perineum (3 patients), leg (2 patients), foot (1 patient), umbilical area (1 patient), ankle (1 patient), scalp (1 patient), and elbow (1 patient). The histologic classification of the tumors included carcinoma (83 patients), malignant melanoma (20 patients), sarcoma and carcinosarcoma (9 patients), malignant mixed Mullerian tumor (2 patients), seminoma (1 patient), malignant teratoma (1 patient), malignant gastrointestinal stromal tumor (1 patient), and neuroblastoma (1 patient). Many of the tumors displayed histologic features that created difficulties for diagnosis and could be easily mistaken on routine histopathologic examination for a variety of primary soft-tissue sarcomas. Routine use of immunohistochemical stains aided in their proper recognition.
CONCLUSIONS.: Metastases are not an infrequent finding in soft tissue and they may represent the initial manifestation of the disease. Use of a basic panel of immunohistochemical stains is recommended for defining the cell type and arriving at the correct diagnosis.
Metastatic lesions localized to the foot are rare. When present, such lesions are typically associated with a poor prognosis. A good history can help guide the clinician when formulating differential diagnoses for a questionable clinical presentation. We report the case of a patient presenting with findings indicative of a metatarsal stress fracture and an ingrown toenail, which eventually resulted in the diagnosis of metastatic disease from the lung
Nasopharyngeal carcinoma is a rare tumor originating from the epithelium of the nasopharynx. Distant metastases involve the lungs, skeleton, liver, and occasionally the choroid. I present the case of a 33-year-old man with stage-IV nasopharyngeal carcinoma and an unusual distant metastasis to the hallux, which has not previously been described in the literature
Metastases to the bones of the lower extremities from prostate carcinomas are rare and are usually associated with diffuse metastatic disease or primary tumors of the abdomen and lungs. I present the case of a patient who presented with lower leg pain and had undiagnosed prostate carcinoma. Unlike previous reports of prostate carcinoma, this rare case includes magnetic resonance imaging, histology, and medical management. This case is unique in its presentation and has not been described previously in the literature
We report the first case of an isolated calcaneal metastasis from prostate cancer. This case highlights the importance of considering metastatic disease in patients with persistent bone pain in the presence of known cancer, however unusual the site.
Metastatic skeletal disease of the foot: case reports and literature review.
Maheshwari AV, Chiappetta G, Kugler CD, Pitcher JD Jr, Temple HT. Foot Ankle Int. 2008 Jul;29(7):699-710.
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BACKGROUND: Metastatic disease of the skeleton occurs in at least 20% to 30% of patients with malignancy, but metastasis to the foot and hand (acrometastasis) is extremely rare (0.007% to 0.3%). Metastases to the feet are even rarer and have been reported in half to one-third the rate for hand metastases. Failure to recognize these lesions has led to delayed diagnosis and/or inappropriate treatment. The purpose of this report is to highlight the clinical and radiologic features that aid in the diagnosis and potential treatment of this condition along with a pertinent review of the literature.
MATERIALS AND METHODS: In a retrospective review of 694 patients with histologically proven metastatic skeletal disease (January 1988 to January 2007), 14 cases of metastatic lesions to the foot were identified. RESULTS: The most frequent primary site was in the genito-urinary system in eight patients and the most common bones involved were the calcaneus and the talus in six patients each. All patients died after a mean survival of 14.8 (range, 1 to 54) months after diagnosis of metastases.
CONCLUSION: Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot, especially if suspicious radiographic changes are present in an older patient. The common primary sites are the genito-urinary, lungs, breast, and the colo-rectum. Treatment is usually palliative to reduce pain and maintain function.
Metastatic lesions to the bones of the foot are rare but pose a challenge to the treating surgeon because of variation in presentation. Cases may present as a painful or swollen toe or as an infection resistant to antibiotics, or they may mimic inflammatory arthropathy. As such, diagnosis may be delayed. Also, with the advent of new therapies for certain cancers, patients living longer have time to develop metastases. The incidence of metastases to the foot is changing. The senior author (HD) has managed 3 consecutive cases of tumorous lesions metastasizing to the foot. Patients included 1 man and 2 women, with an average age of 76.7 years (range, 57-88 years). Open biopsy was performed in 2 cases, whereas true-cut needle biopsy was performed in 1 case. The average follow-up was 16.2 months (range, 8.5-29 years). The pattern and incidence of foot metastases may be changing. Early and accurate diagnosis may help improve patient survival. A working protocol is presented here that can help in diagnosing such lesions
Non-Hodgkin lymphoma metastasis to bone is a rare occurrence in the lower extremity. There have been very few reported cases. Bone metastasis, when it occurs, usually affects the axial skeleton. This article presents a case of Waldenström macroglobulinemia, a variant of non-Hodgkin lymphoma, with metastasis to the right hallux distal phalanx and left cuboid, as well as cutaneous lesions of the right foot. The patient received radiation treatments to each involved area with complete resolution of symptoms and tumor.
Subcutaneous nodules as a sign of malignant lymphoproliferative syndrome.
Fernández-Teijeiro Álvarez A, Galán Del Río P, Quintero Calcaño V, Montiano Jorge JI, Astigarraga Aguirre I, Navajas Gutiérrez A. An Pediatr (Barc). 2009 May 26. [Epub ahead of print]
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Skin involvement in children with malignant processes usually appears at the same time or after the diagnosis of the primary tumour. We present the case of a girl with cutaneous involvement prior to the diagnosis of a malignant lymphoproliferative process. A previously healthy 5-month old girl who presented with an inflammatory subcutaneous lesion on the right foot. During hospital admission due to bronchiolitis at 7 months with associated pancytopenia while the myelogram showed myeloid and megakaryocytic hypoplasia, the abdominal and foot ultrasound were normal. After completing corticoid therapy for her respiratory process and transfusional support, the foot lesion had disappeared at discharge. Two months later she had a local recurrence with associated scattered subcutaneous nodules. The skin biopsy confirmed malignant infiltration; the myelogram showed 6% blast infiltration, and both abdominal ultrasound and CT scan demonstrated lymph node involvement. Immunophenotype confirmed the diagnosis of Precursor B Cell Lymphoblastic Leukemia-Lymphoma. Although complete remission was achieved at the end of the induction chemotherapy according EuroLB-02 protocol for stage IV, the patient presented a refractory leukaemia relapse thirteen months after diagnosis. Commentary: Malignancy should be suspected in the presence of a skin lesion with torpid evolution and biopsy should be considered. Differential diagnosis of malignant skin lesions in children, especially in infants, must include mainly secondary involvement of leukaemia, lymphoma, metastases of neuroblastoma or rhabdomyosarcoma and less frequently other primary processes. In our patient with an isolated cutaneous presentation, the progression of her malignant lymphoproliferative process could be modified by the corticotherapy given before the definitive diagnosis.
Foot drop is commonly caused by lumbar radiculopathy, peroneal nerve injury, spinal stenosis and other systemic diseases. It is usually thought as peripheral etiology, but it could be attributed to a central lesion, too. However, central lesions are rarely reported. We report a case diagnosed as a left parasagittal parietal tumor, in which drop foot was the only abnormal neurologic finding.
Not a metastasis to the foot, but one from the foot:
Orbital metastasis from cutaneous melanoma
Ben Hadj Hamida F, Fezani M, Ben Amor H, Krifa F, Chaabani L, Khalfallah W, Yacoubi S, Ben Rayana N. J Fr Ophtalmol. 2009 Jun;32(6):425-9.
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PURPOSE: We report the case of a patient presenting with a one-sided orbital metastasis from a cutaneous melanoma, and analyze clinical features, diagnostic difficulties and prognosis of such metastasis.
CASE REPORT: We report the case of a woman aged 70 years, who presented with a right one-sided proptosis associated to a decrease of the vision. The clinical features were: visual acuity at 2/10, an axile proptosis and a papillary sectorial temporal atrophy. The computed tomography (CT) disclosed an intraorbital mass with double tonality, rounded and well limited driving back the optic nerve and erasing the limits of the lateral rectus muscle. The orbital magnetic resonance imaging (MRI) showed an intra-conal fusiform mass with an heterogeneous signal in T1 and T2, heightening intensely and heterogeneously after the injection of Gadolinium. Otherwise, the patient presented with an associated respiratory failure, and thoracic CT has disclosed diffuse metastases. It was then noted that a cutaneous melanoma of the left foot had been operated ten years before. The patient died during the following month.
DISCUSSION: The cutaneous melanoma is a rare cause of orbital metastasis. The diagnosis is often easy, when a primitive tumor is known, but it remains uncertain for a long time.
CONCLUSION: Orbital metastases from cutaneous melanoma are rare, generally occurring at the late stage of the disease with a life expectancy not passing one year.
Acrometastasis (metastasis to the hand or foot) is a rare occurrence; however, bone is a common site of metastatic disease, which occurs in up to 30% of patients with malignancy. Although acrometastasis is rare, a high clinical suspicion must exist, especially in evaluating a patient with a known history of cancer. The diagnosis may be difficult and prolonged, which may ultimately affect the patient's outcome. Misdiagnosis of acrometastasis seems to be a common problem. Early diagnosis and treatment is important for improving quality of life in these patients. The authors report 3 cases of acrometastasis from a rare source, the colon.
Metastatic bone involvement of the hallux distal phalanx and cuboid in an elderly patient with non-hodgkin lymphoma.
Allman LM. Foot Ankle Spec. 2008 Dec;1(6):355-8
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Non-Hodgkin lymphoma metastasis to bone is a rare occurrence in the lower extremity. There have been very few reported cases. Bone metastasis, when it occurs, usually affects the axial skeleton. This article presents a case of Waldenström macroglobulinemia, a variant of non-Hodgkin lymphoma, with metastasis to the right hallux distal phalanx and left cuboid, as well as cutaneous lesions of the right foot. The patient received radiation treatments to each involved area with complete resolution of symptoms and tumor.
Metastases to bones of the foot: a case series, review of the literature, and a systematic approach to diagnosis.
El Ghazaly SA, Degroot H.
Foot Ankle Spec. 2008 Dec;1(6):338-43
Quote:
Metastatic lesions to the bones of the foot are rare but pose a challenge to the treating surgeon because of variation in presentation. Cases may present as a painful or swollen toe or as an infection resistant to antibiotics, or they may mimic inflammatory arthropathy. As such, diagnosis may be delayed. Also, with the advent of new therapies for certain cancers, patients living longer have time to develop metastases. The incidence of metastases to the foot is changing. The senior author (HD) has managed 3 consecutive cases of tumorous lesions metastasizing to the foot. Patients included 1 man and 2 women, with an average age of 76.7 years (range, 57-88 years). Open biopsy was performed in 2 cases, whereas true-cut needle biopsy was performed in 1 case. The average follow-up was 16.2 months (range, 8.5-29 years). The pattern and incidence of foot metastases may be changing. Early and accurate diagnosis may help improve patient survival. A working protocol is presented here that can help in diagnosing such lesions.
Bone scintigraphic images of a patient with unusual metastatic alveolar soft-part sarcoma.
Lin YY, Hsieh TC, Kao CH, Wang CH, Wu YC, Yen KY, Sun SS. Clin Nucl Med. 2009 Nov;34(11):806-7.
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Alveolar soft-part sarcoma (ASPS) is a rare soft tissue tumor. Most patients with ASPS present with metastatic disease. The most common sites of metastasis are in the lungs and brain, whereas bone metastases are relatively uncommon.
This case illustrates a rare presentation of metastatic ASPS with foot pain secondary to metatarsal metastasis. Initially, the primary tumor occurred in the left distal thigh. Four years later, brain and lung metastases were found. Another 9 months later, bone metastasis in the right foot was suspected clinically and was confirmed on bone scanning, with additional imaging and histopathology.
Cancer metastasis in the foot
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