Metacarpal Bone Metastasis from Lung Cancer

complete disappearance of both pain and swelling. Thereafter, the patient received 2 courses of platinum-containing chemotherapy. These therapies resulted in a second CR as no other lesion was detected at that time. Although the We previously read with interest the article by Kouvaris et al. (March 2005) on isolated talus metastasis from breast carcinoma [1]. We would like to share our experience with a patient whose condition was very similar to that reported by Kouvaris et al. [1]. Bone metastasis in distal parts of the extremities is very rare [2–4]. This distant spread may imply that cancer cells may reach many sites of the whole body via the bloodstream and the lymphatic system. Like all other metastatic lesions, bone metastasis in distal parts of the extremities reflects the progression of the primary malignancy. This report describes metastasis to the metacarpal bone in the left hand, arising from an adenocarcinoma of the lung. A 78-year-old man with biopsy-proven lung adenocarcinoma in the left upper lung (fig. 1) was referred to our hospital for further evaluation and treatment. The patient was diagnosed as having resectable disease (UICC stage T1N0M0 stage IA). However, because of poor respiratory condition due to chronic obstructive pulmonary disease and a poor performance status, he was evaluated as being not well enough to receive surgical resection or concurrent chemoradiotherapy. A total dose of 64 Gy of chest irradiation was performed, and the response was evaluated as complete response (CR). Two months after the diagnosis of lung cancer, the patient developed a painful swelling of the left hand. X-ray examination showed an osteolytic lesion in the hamate bone (fig. 2). Magnetic resonance imaging demonstrated a metastatic lesion with low signal intensity on T1 weighted image (fig. 3). Small but hot uptake was observed on fluorodeoxyglucose positron emission tomography (FDG-PET). The histological examination of a specimen obtained by biopsy confirmed metastatic lung adenocarcinoma. Because no other abnormal uptake was detected in FDG-PET, the osteolytic manifestation of the left hand was considered the only metastatic site. A total dose of 27 Gy of irradiation was delivered to the left hand, resulting in Fig. 1. Chest computed tomography showing lung adenocarcinoma in the left upper lung.