Metastatic tumors

Metastatic disease in the hand is also very rare, but it is occasionally the first sign of an underlying cancer. In a review of world literature, Kerin [68] found that only about 0.1% of primary tumors metastasize to the hand. In almost 20% of these tumors, the lesion in the hand was the first indication of a primary tumor elsewhere. The most common source was bronchial carcinoma, and the terminal phalanges were the typical site of meta-static disease. Metastatic lesions were less frequently seen in the other phalanges and the metacarpals; one case occurred in the carpus.

The few reports of metastases to the carpus are typically from bronchial carcinoma, although metastases from other tumors such as prostate, breast, larynx, stomach, and bone sarcoma have been described [8,68-79]. Ioia and colleagues [77] reported a case of metastatic bronchial carcinoma to the scaphoid presenting with wrist pain, swelling, and tenderness. The radiographic lesion was initially misdiagnosed as an old scaphoid fracture, reminding the hand surgeon to remain cautious when evaluating any lesion of the wrist.

Patients who have metastases to the carpus usually have bony disease elsewhere and a life expectancy under 6 months. The lesions are often osteolytic on plain radiographs, and may be confused with an infectious or inflammatory processes if the patient's clinical history is not considered. Treatment is directed at symptomatic relief, with either tumor resection or amputation. Radiotherapy may cause fibrosis and stiffness more severe than the scarring associated with surgery.

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