LAUSR

Introduction/Background Metastasis to the nail bed are rare in solid tumor especially endometrial carcinoma. The majority of reported cases are associated with lung, kidney and breast cancers. With only scarce reports on this presentation, subungual metastasis can be misdiagnosed. Methodology We present a case of a multi-metastatic progression of a heavily pretreated, endometrioid uterine carcinoma. The occurrence of her subungual metastasis was precursor of a rapid metastatic progression occurring beside an initial partial response to her systemic treatment. Results A 52-year-old patient with a 3-year history of metastatic low-grade endometrial uterine cancer presented a multi-metastatic progression to the lymph nodes, bone liver and lung. The oncological history included front line chemotherapy with Carboplatinum and Paclitaxel, oral Medroxyprogesterone acetate, Lurbinectedine and Pembrolizumab-Lenvatinib association. A weekly Carboplatinum and Paclitaxel chemotherapy with concomitant Denosumab was initiated. After 3 months, her imaging concluded to a partial response but she reported a new modification in the shape and the color of her fourth right finger nail. Initially attributed to Paclitaxel, the nail deformation increased and resulted in an ingrown nail treated by surgical excision. The pathological examination confirmed a dedifferentiated adenocarcinoma infiltrating the nail. The radiological assessment excluded an underlying bone metastasis. Soon after the diagnosis, the patient presented multiple symptomatic cerebral metastasis and a rapid progressive disease. Conclusion Endometrial carcinoma is rarely associated with subungual metastasis. When observed, subungual metastasis from genitourinary cancers affect mostly lower limbs and terminal phalanges. The metastasis often spreads to the surrounding soft tissues from a primary bone metastasis. Frequent complains include pain and skin erythema. As confirmed by the literature, the occurrence of subungual metastasis is precursor to the rapid fatal progression of the disease. Beside the unexpected topography of the metastasis, the absence of an underlying bone involvement and the mild clinical manifestations were singular features of this progression pattern. Disclosure Nothing to disclose.