title: Calcaneal acrometastasis from urothelial carcinoma of the ureter: a case report and literature review.
abstract: OBJECTIVE
  Ureteral cancer is a rare entity. Typical symptoms are painless hematuria as well as flank pain. Bone metastasis of ureteral cancer can occur in nearby bone structures, such as the spine, pelvis, and hip bone. Distal bone metastasis, such as that in the calcaneus bone, however, is rare.
  
  
  METHODS
  An 82-year-old woman presented to the orthopedic clinic at the university hospital with a 3-month history of left heel pain. A magnetic resonance imaging (MRI) of her foot demonstrated a calcaneal lytic lesion. A biopsy of the lytic lesion showed urothelial carcinoma with squamous differentiation. A computed tomography (CT) scan of the abdomen and pelvis showed left hydronephrosis and an obstructive mass in the left ureter, at the iliac crossing. The patient received combined therapy that included local radiation, bisphosphonate, and chemotherapy, with complete resolution of her cancer-related symptoms. However, she eventually died from the progressive disease, 20 months after the initial diagnosis.
  
  
  CONCLUSIONS
  This case highlights the rare presentation of ureter cancer with an initial presentation of foot pain, secondary to calcaneal metastasis. Multimodality therapy provides effective palliation of symptoms and improved quality of life. We also reviewed the literature and discuss the clinical benefits of multidisciplinary cancer care in elderly patients.
authors.affiliation: Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Ryder
authors.forename: Sean V
authors.initials: SV
authors.lastname: McGarry
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
mesh_terms: D000369:Aged, 80 and over; D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary* / Q000628:therapy; D002111:Calcaneus / Q000473:pathology*; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000473:pathology* / Q000628:therapy
keywords: calcaneal acrometastasis; chemotherapy; elderly; multimodality therapy; radiation; urothelial carcinoma