title: Occult carcinoma of the lung presenting as pain in the hallux: a case report.
abstract: 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.
authors.affiliation: DNB Ortho, FRCS, Welwyn Garden City, Hertfordshire, UK. uramkumar@hotmail.com
authors.forename: U
authors.initials: U
authors.lastname: Ramkumar
authors.forename: N I
authors.initials: NI
authors.lastname: Munshi
authors.forename: J N
authors.initials: JN
authors.lastname: El-Jabbour
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary*; D005260:Female; D006214:Hallux / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008875:Middle Aged; D010146:Pain / Q000209:etiology