Skuamöz hücreli akciğer kanserinde izole ayak metastazı: Ender yerleşimli bir olgu

Abstract

Skuamöz hücreli akciğer kanseri metastatik olmaktan ziyade lokal bir hastalıktır. Bu çalışmamızda sunduğumuz lokal ilerlemiş skuamöz hücreli akciğer kanseri tanısı alan 55 yaşındaki erkek hasta, 2 ay sonra ortopedi kliniğine sol ayak bileği çevresinde ağrı ve rahatsızlık şikayetiyle başvurmuştu. Fizik muayenede ayak bileği çevresinde lokalize edilemeyen ağrı ve hassasiyet saptanmıştır. T2 ağırlıklı MR görüntülerinde talus başı ve boynu çevresinde kemik iliği ödemi benzeri alanlar görülmüştür. Tüm vücut dinamik kemik sintigrafisinde sadece ayakta metastatik bir lezyon saptanmıştır. Hasta metastaz tanısı koyulmasının ardından 4 ay sonra kaybedilmiştir. Ayak metastazının erken tanısı zorlu bir süreç olmakla beraber yapılan çalışmalarda tanının konulmasında 24 aya varan gecikmelerden bahsedilmektedir. Kemik metastazları genellikle ilerlemiş metastatik hastalıkla birlikte görülür ve sağkalım beklentisi çok düşüktür. Ayak metastazları nadir görülmelerine rağmen yaşlı bir akciğer kanseri hastasında ağrılı bir ayağın tanı sürecinde akılda tutulmalıdır. Yaşam süresi beklentisinin kısa olduğu hastalarda ağrı kesiciler gibi palyatif tedavilerin seçilmesi daha uygun olacakken, uzun yaşam süresi beklenen hastalarda ise agresif tedavi yaklaşımları uygulanabilir.

Keywords

• Akciğer; ayak; kanser; metastaz; skuamöz hücreli kanser; talus; tarsal kemik.

Isolated foot metastasis of squamous cell carcinoma of the lung: a rare location

Abstract

Squamous cell carcinoma of the lung usually presents as a local rather than a metastatic disease. We present a 55-year-old male who was referred to the orthopedics and traumatology clinic for evaluation of pain and discomfort around the left ankle 2 months after diagnosis of locally advanced non-small cell (squamous cell) lung cancer. Physical examination revealed nonspecific pain and tenderness around the ankle. T2-weighted MR images showed lesions like a bone marrow edema around the talar head and neck. Whole body dynamic bone scan revealed a metastatic lesion only in the foot. The patient died 4 months after diagnosis of the metastasis. Early diagnosis of foot metastasis may be challenging and delays in diagnosis of up to 24 months have been reported. Foot metastases are usually associated with advanced metastatic disease and survival rates are poor. Although metastatic disease of the foot is rare, it should be considered in the diagnosis of a painful foot in the elderly lung cancer patients. Palliative treatments such as pain relief medications should be chosen for patients with an expectancy of short survival whereas aggressive approaches may be applied for those with longer survival expectations.

Keywords

• Cancer
• foot
• lung
• metastasis
• squamous cell carcinoma
• talus
• tarsal bone

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