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Paper text:
we report a case of metastasis to the proximal phalanx of the left hand as the initial manifestation of a lung adenocarcinoma .
a 61-year - old male smoker presented in december 2013 at the chu sud runion with pain in his left ring finger and in the ribs , both secondary to indirect trauma a few weeks ago .
he had no other complaints and was in good general condition . on physical examination of the hand ,
his left ring finger measured 80 mm in circumference , while the contralateral healthy finger had a circumference of 55 mm .
we performed an x - ray of the rib cage , which showed a lytic lesion of the eighth rib .
an x - ray of the left hand showed a lytic bone lesion with the destruction of the bone cortex in the proximal phalanx and a swelling of the surrounding soft tissue ( fig .
2 ) . a ct scan of the chest showed several suspicious opacities , one in the left lung hilum , a stellar image at the apex of the right lung , and a lytic lesion of the anterior arc of the eighth rib ( fig .
then a biopsy of the rib mass identified an infiltration of the parietal pleura and striated muscle tissue by a pulmonary adenocarcinoma , moderately differentiated ttf1 + , kras mutant , braf wild type , egfr wild type , and with no alk rearrangement .
the bone scintigraphy showed multiple bone metastases on the rib cage , the spine , and the left scapula .
the patient received radiotherapy for his left ring finger in march 2014 ( dose of total 30 gy/10 fractions , 5 fractions / week , 6-mv x - rays with 5-mm bolus ) . over the next month , the left ring finger became much less painful .
an x - ray of the left hand done 1 month after the end of the radiotherapy showed a decrease of the soft tissue swelling and an early reossification of the proximal phalanx ( fig .
chemotherapy with cisplatin , pemetrexed and bevacizumab was started at the end of the radiotherapy .
peripheral bone metastases are mostly associated with disseminated disease , but in our case , it was the initial manifestation of a lung adenocarcinoma .
it can be easily confused with an infection ; an x - ray can be very helpful .
pathology may be necessary in case of doubt and additional exams such as chest ct and bronchoscopy should be performed to identify the primary lesion .
patients mostly have to be treated with an amputation of the finger [ 7 , 8 , 9 , 10 , 11 ] . patients with bone metastases have a median survival of only 6 months , and a choice of treatment should be made considering this poor prognosis : palliative radiotherapy and non - steroidal analgesics helped our patient and improved his quality of life .
phalanx bone metastasis as the initial presenting sign of lung cancer is a rare presentation . 
 lung cancer is known to metastasize to the bone , but rarely to the fingers . a 61-year - old male smoker presented with pain in the left ring finger . 
 severe pain discouraged the patient from using his left hand . 
 an x - ray of the left hand showed a lytic bone lesion . 
 the patient was treated with finger radiotherapy . 
 analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life . 
 palliative radiotherapy relieved our patient and improved his quality of life .