Calcaneal metastases, urothelial origin

Our patient is a 78-year-old lady with known metastatic papillary urothelial carcinoma that presented for evaluation of left foot pain. Imaging studies revealed an aggressive appearing mass measuring approximately 4.8 cm that was subsequently biopsied with pathology consistent with her known diagnosis of urothelial carcinoma. Acrometastasis, formally defined as bone metastases located distally to the elbow and knee, remains a very rare phenomenon in metastatic disease. The prevalence in literature has been cited as low as 0.1% of all bone metastases. It is often cited as a poor prognostic indicator in solid malignancies. We were very fortunate to capture this image at our small community hospital and wanted to share our findings with the journal. We feel that the images chosen were the best in depicting the aggressive nature of metastatic urothelial carcinoma. The MRI image (panel A) reveals a mostly circumscribed, aggressive appearing lesion situated within the posterior inferior calcaneum with surrounding marrow tissue. (Panel B) depicts a zoomed picture of direct invasion of urothelial tumor cells into trabeculated bone tissue.