每日一题_2025.07.10

A 55-year-old man with metastatic squamous-cell lung cancer presented to the hospital with a 6-week history of pain and swelling of the right great toe and tip of the right middle finger. He reported no history of fever. On physical examination, swelling and erythema of the distal phalanx of the right third finger and right great toe. There was also an area of ulceration adjacent to the great toenail. The lesions were firm and tender to palpation. Radiographs of the hands and feet were taken. Which of the following is the most likely underlying cause of the findings?

一名55岁男性，患有转移性鳞状细胞肺癌，因右大脚趾和右手中指指尖疼痛、肿胀持续6周前来就诊。患者自述无发热史。体格检查发现：右手中指远节指骨及右大脚趾存在肿胀与红斑，大脚趾指甲旁有一处溃疡区域，病灶触诊时质地坚硬且有压痛。已拍摄手足部X线片。以下哪项最可能是导致上述表现的根本原因？

A. Acrometastases肢端转移瘤

B. Gout痛风

C. Osteomyelitis骨髓炎

D. Psoriatic arthritis银屑病关节炎

E. Trauma-induced osteonecrosis创伤性骨坏死

答案解析：

手足部X线片显示，第三指远节指骨和大脚趾的骨质被破坏性溶骨性病变完全取代。据此诊断为肢端转移瘤。

肢端转移瘤是一种罕见的骨转移类型，发生在肘关节或膝关节以远部位。虽然肢端转移瘤在临床表现上可能与痛风或骨髓炎相似，但在正确的临床背景下，普通X线检查有助于明确诊断。

正确答案：A