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A 51-year-old woman with a medical history noteworthy for endometrioid ovarian carcinoma presented with progressive left thumb swelling in the absence of trauma or injury. Radiographs revealed a lytic lesion in the distal phalanx. Inflammatory markers and white blood-cell count were mildly elevated. The thumb was amputated at the interphalangeal joint, and pathologic examination identified the lesion as an adenocarcinoma, consistent with the known endometrioid ovarian carcinoma.The similar presentation of tumor and infection can present a diagnostic challenge. Despite the rare incidence of osseous metastases to the hand, orthopaedic surgeons must consider metastatic bone lesions in patients presenting with swollen or painful fingers.