A Case of Hypertrophic Osteoarthropathy Associated with Nasopharyngeal Carcinoma in a Child

Abstract

Hypertrophic osteoarthropathy is characterized by clubbing of the digital tips and periosteal reaction of long bones. Most of the cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia, and gastrointestinal polyps. Hypertrophic osteoarthropathy associated with malignancy is rare in children. A few cases of hypertrophic osteoarthropathy in children with nasopharyngeal carcinoma have been reported, however, there has been no report of such case in Korea. We present a case of hypertrophic osteoarthropathy associated with nasopharyngeal carcinoma with lung metastasis in a 14-yr-old boy. In this case, hypertrophic osteoarthropathy regressed after intensive chemotherapy, but subsequently the patient died of progressive lung metastasis.

Childhood intrathoracic Hodgkin lymphoma with hypertrophic pulmonary osteoarthropathy: a case report and review of the literature

“…To our knowledge, only 33 pediatric patients with HOA have been reported to have neoplastic diseases to date. Among these, 12 had carcinoma of the nasopharynx, eight had osteosarcoma, eight had HL, three had thymic carcinoma, one had periosteal sarcoma and one had pleural mesothelioma [14,16,21,22]. The present case is the ninth pediatric HOA secondary to HL reported in the medical literature [1,6,[14][15][16][17]20].…”

“…HOA may precede the identification of an intrathoracic lesion [21,22], as seen in six patients of this HL group. HOA developing during the course of the neoplastic disease implies poor prognosis and may indicate recurrent or metastatic disease [22,24].…”

Osteoartropatia hipertrófica associada a linfoepitelioma de nasofaringe: relato de caso

“…5 Some patients may rarely present a paraneoplastic syndrome, Hypertrophic osteoarthropathy (HOA), a condition characterized by digital clubbing, periostitis of long tubular bones, polyarthralgia and synovial effusion, most prominent in the large joints. 3,7,8 OAH can be classified in primary, when it's not associated with any medical condition; and secondary, which can be divided into pulmonary causes such as cystic fibrosis, primary or metastatic carcinoma, and non-lung, such as cyanotic congenital heart disease, liver cirrhosis, intestinal polyps, among other pathologies. 3,7 Although the pathophysiology of HOA remains controversial, there are two different theories attempting to explain it.…”

“…3,7,8 OAH can be classified in primary, when it's not associated with any medical condition; and secondary, which can be divided into pulmonary causes such as cystic fibrosis, primary or metastatic carcinoma, and non-lung, such as cyanotic congenital heart disease, liver cirrhosis, intestinal polyps, among other pathologies. 3,7 Although the pathophysiology of HOA remains controversial, there are two different theories attempting to explain it. 7,8 The neurological theory, sustained by vagal nerve stimulation, is supported by the regression of the syndrome after vagotomy.…”

“…3,7 Although the pathophysiology of HOA remains controversial, there are two different theories attempting to explain it. 7,8 The neurological theory, sustained by vagal nerve stimulation, is supported by the regression of the syndrome after vagotomy. 7,8,9 The humoral theory, proposed by some authors, is based on the presence of factors in the venous circulation, such as megakaryocytes, which are usually removed or fragmented by the lungs.…”