JCT  Vol.2 No.2 , June 2011
Digital Ischemia in Patients with Solid Tumors: a Case Report and Review of the Literature
Abstract: Digital ischemia is a rare paraneoplastic phenomenon associated with various malignancies, especially adenocarcinomas. We reported a case of digital ischemia onset during treatment with capecitabine + oxaliplatin, letrozole and epoetinbeta in a 75-year old woman with colon and breast cancer and a secondary hepatic lesion. A literature review disclosed 68 cases of solid neoplasms associated with digital ischemia. The proposed mechanisms of such clinical manifestations are various: vasospasm due to sympathetic hyperactivity, arteritis induced by tumour antigen-antibody complexes deposition or as consequence of immune deregulation, blood hyperviscosity, hypercoagulability or peripheral thrombosis. In the present case, clinical and laboratory evaluations failed to reveal evidence of thrombosis, arteritis, inherited or acquired hypercoagulable state and we postulated the peripheral vasospasm and the sympathetic activity (possibly due to chemotherapy drugs) as potential causes of the digital ischemia.
Cite this paper: nullL. Raimondo, C. Cella, R. Moretto, E. Matano and C. Carlomagno, "Digital Ischemia in Patients with Solid Tumors: a Case Report and Review of the Literature," Journal of Cancer Therapy, Vol. 2 No. 2, 2011, pp. 281-284. doi: 10.4236/jct.2011.22036.

[1]   M. Konstantinos, B. Nikolaos, M. Dimitris and A. Vasilios, “Digital Ischemia as a Paraneoplastic Manifes- tation of Lung Cancer,” Internal Medicine, Vol. 49, No. 2, 2010, pp. 199-200. doi:10.2169/internalmedicine.49.2756

[2]   V. Ajit, “Trousseau’s Syndrome: Multiple Definitions and Multiple Mechanisms,” Blood, Vol. 16, No. 6 (Sup- plement), 2007, pp. 1723-1729.

[3]   Common Terminology Criteria for Adverse Events, Version 3.0, 2006.

[4]   L. M. Taylor, M. D. Hauty, J. M. James and J. M. Edwards, “Digital Ischemia as a Manifestation of Malig- nancy,” Annals of Surgery, Vol. 206, No. 1, 1987, pp. 62-68. doi:10.1097/00000658-198707000-00010

[5]   S.-F. Chow and C. H. McKenna, “Ovarian Cancer and Gangrene of the Digits: Case Report and Review of the Literature,” Mayo Clinic Proceedings, Vol. 71, No. 3, 1996, pp. 253-258. doi:10.4065/71.3.253

[6]   J. Field and I. F. Lane, “Carcinoma of the Lung Presenting with Digital Ischaemia,” Thorax, Vol. 41, No. 7, 1986, pp. 573-574. doi:10.1136/thx.41.7.573

[7]   P. D. L. Maurice, “Ovarian Carcinoma and Digital Ischemia,” Clinical and Experimental Dermatology, Vol. 21, No. 5, 1996, pp. 381-382. doi:10.1111/j.1365-2230.1996.tb00130.x

[8]   P. R. Hawley, A. W. Johnston and J. T. Rankin, “Association between Digital Ischemia and Malignant Disease,” British Medical Journal, Vol. 3, No. 5559, 1967, pp. 208-212. doi:10.1136/bmj.3.5559.208

[9]   P. A. Courtney, S. Sandhu, P. V. Gardiner and A. L. Bell, “Resolution of Digital Necrosis Following Treatment of Multiple Myeloma,” Rheumatology, Vol. 39, No. 10, 2000, pp. 1163-1164. doi:10.1093/rheumatology/39.10.1163

[10]   J. R. Wright and S. Gudelis, “Digital Necrosis Associated with Squamous Cell Carcinoma of the Tonsil,” Head & Neck, Vol. 24, No. 11, 2002, pp. 1019-1021. doi:10.1002/hed.10155

[11]   G. Wendela, J. P. Baars, P. C. de Jong and A. M. Westermann, “Digital Ulceration as a Paraneoplastic Syndrome in Ovarian Cancer,” Journal Of Clinical Oncology, Vol. 21, No. 13, 2003, pp. 2620-2625. doi:10.1200/JCO.2003.07.099

[12]   P. Kopterides, T. Nikolas, T. Athanasios, P. dimitrios and L. Andreas, “Digital Gangrene and Raynaud’s Pheno- menon as Complications of Lung Adenocarcinoma,” Lancet Oncology, Vol. 5, No. 9, 2004, p. 549. doi:10.1016/S1470-2045(04)01566-9

[13]   H. Srisha and T. Gareth, “Digital Ischemia Associated with Squamous Cell Carcinoma of the Esophagus,” Digestive Disease and Science, Vol. 50, No. 4, 2005, pp. 691-693. doi:10.1007/s10620-005-2558-0

[14]   M. V. Paolini, G. Jankilevinch, C. Graziano and D. S. Fernandez Romero, “Fulminant Digital Necrosis in a Patient with Prostate Adenocarcinoma,” Allergology and Immunophatology (Madrid), Vol. 38, No. 1, 2010, pp. 48-50. doi:10.1016/j.aller.2009.06.006

[15]   R. Ponzone, P. Minianni, E. Cassina, F. Pastorino and P. Sismondi, “Aromatase Inhibitors for Breast Cancer: Different Structures, Same Effect?” Endocrine-Related Cancer, Vol. 15, No. 1, 2008, pp. 27-36. doi:10.1677/ERC-07-0249

[16]   J.-M. A. Nabholtz, “Long Term Safety of Aromatase Inhibitors in the Treatment of Breast Cancer,” Thera- peutics and Clinical Risk Management, Vol. 4, No. 1, 2008, pp. 189-204.

[17]   M. Dicato, “Venous Thromboembolic Events and Erythropiesis Stimulating Agents: An Update,” The Oncolo- gist, Vol. 13, No. 3 (Supplement), 2008, pp.11-15. doi:10.1634/theoncologist.13-S3-11

[18]   C. Ang, M. Kornbluth, M. P. Thirlwell and R. D. Rajan, “Capecitabine-Induced Cardiotoxicity: Case Report and Review of the Literature,” Current Oncology, Vol. 17, No. 1, 2010, pp. 59-63. doi:10.3747/co.v17i1.437

[19]   S. R. McWhinney, R. M. Goldberg and H. L. McLeod, “Platinum Neurotoxicity and Pharmacogenetics,” Molecu- lar Cancer Therapy, Vol. 8, No. 1, 2010, pp. 10-16. doi:10.1158/1535-7163.MCT-08-0840