Concurrent Intrathoracic Hodgkin's Disease and Hypertrophic Osteoarthropathy

Hypertrophic osteoarthropathy in a child due to thoracic Hodgkin’s disease

“…Hypertrophic osteoarthropathy in children is rare and is typically considered to be a sign of pulmonary disease [1][2][3]. However, it may be related to a variety of inflammatory or neoplastic disorders, including congenital heart diseases, pulmonary or cystic fibrosis, infectious airway disease, chronic liver and inflammatory bowel disease as well as various intrathoracic and gastrointestinal tumours [1][2][3].…”

“…However, it may be related to a variety of inflammatory or neoplastic disorders, including congenital heart diseases, pulmonary or cystic fibrosis, infectious airway disease, chronic liver and inflammatory bowel disease as well as various intrathoracic and gastrointestinal tumours [1][2][3]. While up to 90% of HPOA cases are associated with primary or metastatic pulmonary neoplasms in adults, intrathoracic malignant disease accounts for only 12% of HPOA cases in children [1][2][3]. The presence of HPOA has been regarded as a poor prognostic sign, since most of the patients with malignancy and HPOA have showed extensive metastases [2].…”

“…The presence of HPOA has been regarded as a poor prognostic sign, since most of the patients with malignancy and HPOA have showed extensive metastases [2]. Therefore, although HPOA is rare in childhood cancers, its occurrence should alert physicians for the recurrence of disease or intrathoracic involvement during follow-up [2][3][4].…”

“…HPOA has a characteristic radiological appearance [1][2][3][4]. Initially, there is periosteal new bone formation forming a thin radiopaque line around the cortex and separated from it by a radiolucent band.…”

“…Subsequently, the two layers gradually fuse and lead to poorly demarcated or lamellar periosteal reaction. This appearance may be easily differentiated from bone involvement from the Hodgkin's disease itself, as periosteal infiltration by lymphoma usually affects the anterior surfaces of the vertebral bodies rather than the long bones and is always associated with cortical bone destruction [1][2][3][4].…”