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Paraneoplastic musculoskeletal disorders: review and update for radiologists. Skeletal Radiol 2023; 52:421-433. [PMID: 35604445 DOI: 10.1007/s00256-022-04074-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023]
Abstract
Rheumatic paraneoplastic syndromes are rare syndromes that occur at distant sites from the underlying tumor and may involve the bones, joints, fasciae, muscles, or vessels. In the absence of a known tumor, early recognition of a rheumatic syndrome as paraneoplastic permits dedicated work-up for, and potentially early treatment of an occult malignancy. Although there is a continuously growing list of paraneoplastic rheumatic disorders, not all of these disorders have a well-established association with a neoplastic process. The goals of this article are to review the clinical characteristics, diagnostic work-up, and imaging findings of well-documented rheumatic paraneoplastic disorders.
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Hypertrophic Osteoarthropathy Associated with Probable Smear-Negative Pulmonary Tuberculosis. Case Rep Rheumatol 2022; 2022:5429138. [PMID: 36032797 PMCID: PMC9410991 DOI: 10.1155/2022/5429138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022] Open
Abstract
Association of hypertrophic osteoarthropathy (HOA) with pulmonary tuberculosis is rarely reported, especially with smear-negative pulmonary tuberculosis (SNPT), in which its diagnosis is a challenge. We used a systematic approach to analyze all relevant literature reviews, and we identified only two cases of HOA associated with pulmonary tuberculosis in the last 10 years. We report the case of a 36-year-old man who presented with bilateral symmetric polyarthralgia and digital clubbing. Laboratory exams associated elevated acute phase reactants with negative immunological examinations. Two series of three acid-fast Bacillus (AFB) smear microscopy in sputum, separated by 15 days of broad-spectrum antibiotic therapy, were negative. A sputum culture was negative for Mycobacterium tuberculosis. A chest X-ray and computed tomography (CT) showed an apical pulmonary cavity. Plain X-ray and bone scintigraphy revealed periostosis of the tubular bones. Therefore, the diagnosis of HOA associated with probable SNPT was made. HOA symptoms had remitted after 3 months of antitubercular therapy. After 7 months of treatment, chest CT and bone scintigraphy showed a regression of the pulmonary cavity and disappearance of periostosis. The search for tuberculosis in front of any HOA seems to be justified in our epidemiological context.
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Liu Y, Wang N, Xu J, Bi Y, Han X, Dai M, Liu C. Small cell lung cancer with relapsing polychondritis: A report of one case and the review of literature. Int J Immunopathol Pharmacol 2022; 36:3946320221120962. [PMID: 35968643 PMCID: PMC9379949 DOI: 10.1177/03946320221120962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study reports the clinical data of a patient with small cell lung cancer who
developed relapsing polychondritis. We report a case of a 57-year-old female presented
with cough, expectoration, and fever. A Computed Tomography (CT) scan performed at the
hospital revealed diffuse thickening of bronchial walls in both lungs. Bronchoscopy
revealed that the tracheal mucosa was thickened, narrowed, and collapsed, and the
bronchoscope could pass through. The bronchial mucosa on both sides was thickened and
edematous, the surface was rough, each bronchus was narrow, and the intervertebral ridges
were widened. Needle biopsy: considering small cell carcinoma in combination with
immunohistochemical results. Her symptom was not improved after anti-infective therapy.
The left auricle was red and swollen, the auricle collapsed, and the left eye had
subconjunctival hemorrhage during her hospitalization without obvious cause. After
multidisciplinary consultation, pulmonary small cell lung cancer cT0N2Mx rumen lymph node
metastasis and RP were considered. Treatment: Prednisone, orally for RP. Chemotherapy
combined with radiotherapy was given for small cell lung cancer. The chemotherapy regimen
was carboplatin combined with etoposide. The patient has already been followed for 1 year
after receiving chemoradiotherapy; the condition of the patient is stable at present.
Based on the case of our patient, for cases of RP with symptoms such as auricle
chondritis, ocular inflammatory disease, and nasal chondritis, we should pay great
attention to whether the case is caused by lung cancer with relapsing polychondritis.
Because of the rarity of the disease, the clinician should improve the recognition of the
disease in order to strive for early diagnosis and therapy.
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Affiliation(s)
- Yuan Liu
- Department of Pneumology, 74545Dalian Municipal Central Hospital, Dalian, China
| | - Ning Wang
- Department of Medical Examination Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Xu
- Department of Pneumology, 74545Dalian Municipal Central Hospital, Dalian, China
| | - Ying Bi
- Department of Pneumology, 74545Dalian Municipal Central Hospital, Dalian, China
| | - Xue Han
- Department of Pneumology, 74545Dalian Municipal Central Hospital, Dalian, China
| | - Meng Dai
- Department of Pneumology, 74545Dalian Municipal Central Hospital, Dalian, China
| | - Chunfang Liu
- Department of Pneumology, 74545Dalian Municipal Central Hospital, Dalian, China
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Oh KS, Lee SY, Min SH, Ryu C, Shin HY. Hypertrophic osteoarthropathy in renal cell carcinoma - A case report. Anesth Pain Med (Seoul) 2021; 16:290-294. [PMID: 34233412 PMCID: PMC8342818 DOI: 10.17085/apm.20092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hypertrophic osteoarthropathy (HOA) is a rare clinical condition including an abnormal periosteal reaction in the long bones that causes painful swelling and tenderness of the extremities, digital clubbing, arthritis, synovitis, and joint effusions. Most cases are associated with tumorous conditions and most commonly with lung cancer. HOA has been rarely reported in association with other cancers. Case A patient with a history of recurrent renal cell carcinoma was referred to our clinic with bilateral leg pain, knee joint effusion, and arthritis. Simple radiography and bone scintigraphy confirmed a diagnosis of HOA. Oral non-steroidal anti-inflammatory drugs, joint fluid aspiration, and intra-articular injection of pain medications were found to be effective in the management of HOA pain. Conclusions HOA prognosis depends on the underlying disease, therefore, cancer treatment is critical. This case demonstrates the need to consider HOA in patients with various malignancies who present with bone or joint pain of the extremities.
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Affiliation(s)
- Kyung Seo Oh
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Seung Young Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Choongun Ryu
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hwa-Yong Shin
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
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Matralis D, Panopoulos I, Papadogiannaki I, Van der Lugt J, Papadogiannakis E. Hypertrophic osteopathy associated with lepidic pulmonary adenocarcinoma in a cat. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Elhamiani Khatat S, Vallefuoco R, El Mrini M, Canonne-Guibert M, Rosenberg D. Renal adenocarcinoma associated with hypertrophic osteopathy in a cat. JFMS Open Rep 2020; 6:2055116920962433. [PMID: 33282332 PMCID: PMC7686623 DOI: 10.1177/2055116920962433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Case summary A 10-year-old neutered male domestic shorthair cat was diagnosed
with renal adenocarcinoma associated with hypertrophic
osteopathy. The cat was referred for chronic ambulation
difficulties. The physical examination showed a painful
thickening of all four limbs, a right cranial abdominal mass and
a conjunctival hyperaemia. Radiographic findings were consistent
with extensive periosteal new bone formation involving not only
the diaphyses of the fore- and hindlimbs, but also of the
pelvis, tarsus and carpus. Abdominal ultrasonography and CT
revealed a mass within the right kidney and a primary neoplasm
was suspected. A ureteronephrectomy of the right kidney was
performed and histopathology confirmed the diagnosis of renal
adenocarcinoma. Although clinical improvement of the lameness
occurred after surgery, no radiographic changes of hypertrophic
osteopathy lesions were observed at the 9-month follow-up. Relevance and novel information Feline cases of hypertrophic osteopathy are rarely reported in the
literature and only a few of them were associated with abdominal
neoplastic diseases. To our knowledge, this is the first case of
renal adenocarcinoma associated with hypertrophic osteopathy in
a cat.
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Affiliation(s)
- Sarah Elhamiani Khatat
- Department of Medicine, Surgery and Reproduction, Hassan II Institute of Agronomy and Veterinary Medicine, Rabat, Morocco
| | | | - Meryem El Mrini
- Department of Animal Production, National Office of Sanitary Safety of Food Products, Rabat, Morocco
| | - Morgane Canonne-Guibert
- Department of Small Animal Internal Medicine, University Hospital Center, National Veterinary Schooll of Maisons-Alfort, University of Paris-Est Créteil, Val-de-Marne, France
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Yap FY, Skalski MR, Patel DB, Schein AJ, White EA, Tomasian A, Masih S, Matcuk GR. Hypertrophic Osteoarthropathy: Clinical and Imaging Features. Radiographics 2016; 37:157-195. [PMID: 27935768 DOI: 10.1148/rg.2017160052] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertrophic osteoarthropathy (HOA) is a medical condition characterized by abnormal proliferation of skin and periosteal tissues involving the extremities and characterized by three clinical features: digital clubbing (also termed Hippocratic fingers), periostosis of tubular bones, and synovial effusions. HOA can be a primary entity, known as pachydermoperiostosis, or can be secondary to extraskeletal conditions, with different prognoses and management implications for each. There is a high association between secondary HOA and malignancy, especially non-small cell lung cancer. In such cases, it can be considered a form of paraneoplastic syndrome. The most prevalent secondary causes of HOA are pulmonary in origin, which is why this condition was formerly referred to as hypertrophic pulmonary osteoarthropathy. HOA can also be associated with pleural, mediastinal, and cardiovascular causes, as well as extrathoracic conditions such as gastrointestinal tumors and infections, cirrhosis, and inflammatory bowel disease. Although the skeletal manifestations of HOA are most commonly detected with radiography, abnormalities can also be identified with other modalities such as computed tomography, magnetic resonance imaging, and bone scintigraphy. The authors summarize the pathogenesis, classification, causes, and symptoms and signs of HOA, including the genetics underlying the primary form (pachydermoperiostosis); describe key findings of HOA found at various imaging modalities, with examples of underlying causative conditions; and discuss features differentiating HOA from other causes of multifocal periostitis, such as thyroid acropachy, hypervitaminosis A, chronic venous insufficiency, voriconazole-induced periostitis, progressive diaphyseal dysplasia, and neoplastic causes such as lymphoma. ©RSNA, 2016.
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Affiliation(s)
- Felix Y Yap
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - Matthew R Skalski
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - Dakshesh B Patel
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - Aaron J Schein
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - Eric A White
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - Anderanik Tomasian
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - Sulabha Masih
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
| | - George R Matcuk
- From the Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, 2nd Floor Imaging, Los Angeles, CA 90033 (F.Y.Y., D.B.P., A.J.S., E.A.W., A.T., G.R.M.); Department of Radiology, Southern California University of Health Sciences, Whittier, Calif (M.R.S.); and Department of Radiology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, Calif (S.M.)
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Zuckier LS, Martineau P. Altered Biodistribution of Radiopharmaceuticals Used in Bone Scintigraphy. Semin Nucl Med 2015; 45:81-96. [DOI: 10.1053/j.semnuclmed.2014.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
For patients that present with musculoskeletal symptoms, diagnostic procedures carried out by physicians and rheumatologists are primarily aimed at confirming or excluding the occurrence of primary rheumatic diseases. Another important trigger for musculoskeletal disease, however, is the presence of a tumour. Careful clinical investigation and knowledge of the gestalt of musculoskeletal syndromes related to respective tumour entities is of utmost importance for the diagnosis of paraneoplastic rheumatic diseases such as hypertrophic osteoarthropathy, paraneoplastic polyarthritis, RS3PE syndrome, palmar fasciitis and polyarthritis, cancer-associated myositis and tumour-induced osteomalacia. This places great responsibility on rheumatologists in diagnosing malignancies and referring the patient for effective treatment. The selective influence of tumours on musculoskeletal tissue is surprising and indicates that tumours alter tissues such as the periosteum, synovial membrane, subcutaneous connective tissue, fascia, muscles and bones by specific molecular processes. Some of the underlying mechanisms have been unravelled, providing valuable information on the physiologic and pathophysiologic roles of mediators such as vascular endothelial growth factor and fibroblast growth factor 23.
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Affiliation(s)
- Bernhard Manger
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Ulmenweg 18, D-91054 Erlangen, Germany
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Kanaji N, Watanabe N, Kita N, Bandoh S, Tadokoro A, Ishii T, Dobashi H, Matsunaga T. Paraneoplastic syndromes associated with lung cancer. World J Clin Oncol 2014; 5:197-223. [PMID: 25114839 PMCID: PMC4127595 DOI: 10.5306/wjco.v5.i3.197] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 04/12/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases. Paraneoplastic syndromes associated with lung cancer can impair various organ functions and include neurologic, endocrine, dermatologic, rheumatologic, hematologic, and ophthalmological syndromes, as well as glomerulopathy and coagulopathy (Trousseau’s syndrome). The histological type of lung cancer is generally dependent on the associated syndrome, the two most common of which are humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer. The symptoms often precede the diagnosis of the associated lung cancer, especially when the symptoms are neurologic or dermatologic. The proposed mechanisms of paraneoplastic processes include the aberrant release of humoral mediators, such as hormones and hormone-like peptides, cytokines, and antibodies. Treating the underlying cancer is generally the most effective therapy for paraneoplastic syndromes, and treatment soon after symptom onset appears to offer the best potential for symptom improvement. In this article, we review the diagnosis, potential mechanisms, and treatments of a wide variety of paraneoplastic syndromes associated with lung cancer.
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Marengo MF, Suarez-Almazor ME, Lu H. Neoplastic and Paraneoplastic Synovitis. Rheum Dis Clin North Am 2011; 37:551-72. [DOI: 10.1016/j.rdc.2011.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Huang CH, Jeng CR, Lin CT, Yeh LS. Feline hypertrophic osteopathy: a collection of seven cases in Taiwan. J Am Anim Hosp Assoc 2010; 46:346-52. [PMID: 20810556 DOI: 10.5326/0460346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Between October 2003 and May 2004, seven cats were diagnosed with severe and extensive hypertrophic osteopathy of the appendicular skeleton without detectable underlying causes. All cats showed similar clinical signs of pain with progressive lameness of the limbs. One cat died shortly after presentation, whereas conditions of the others resolved after medical treatment and a change in diet. Regression of the bone lesions was observed radiographically in all surviving six cases.
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Affiliation(s)
- Chiung-Hui Huang
- Department of Veterinary Medicine, Graduate Institute of Veterinary Medicine and Veterinary Teaching Hospital, National Taiwan University, Number 1, Section 4, Roosevelt Road, Taipei City 106, Taiwan
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Review of current therapies for secondary hypertrophic pulmonary osteoarthropathy. Clin Rheumatol 2010; 30:7-13. [PMID: 20936419 DOI: 10.1007/s10067-010-1563-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 08/30/2010] [Indexed: 10/19/2022]
Abstract
Hypertrophic osteoarthropathy (HOA) is a disabling condition that may occur secondarily to primary lung cancer. It is characterized by digital clubbing, arthralgia/arthritis, and periostosis of the tubular bones. The pain associated with HOA can be disabling and often refractory to conventional analgesics. We performed a comprehensive review of the literature using the PubMed database on treatment modalities available for HOA. We found 52 relevant articles-40 case reports, six case series, two review papers, and four combined case series and review papers. There were no randomized controlled trials reported. We then classified treatments used for HOA into two categories: (1) treatment of primary cause (i.e., resection of tumor, chemotherapy, radiotherapy, treatment of infection, etc.) and (2) symptomatic treatments (i.e., bisphosphonates, octreotide, NSAIDs, vagotomy, etc.). Subsequently, we summarized the main findings for each treatment. Although the clinical diagnosis of HOA has existed for over 100 years, the pathogenesis mechanism has not yet been elucidated, and treatment options for this condition remain experimental. Primary treatment is the most widely reported modality to be efficacious. In cases which primary therapy is not possible, several symptomatic treatment modalities are suggested, with various degree of success. Further research is needed to clarify the pathophysiological mechanism of HOA as to appropriately direct therapy.
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Hypertrophic osteoarthropathy manifested with isolated calcaneal periostitis in bone scintigraphy. Ann Nucl Med 2010; 24:313-7. [DOI: 10.1007/s12149-010-0344-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
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Hypertrophic pulmonary osteoarthropathy diagnosed by FDG PET-CT in a patient with lung adenocarcinoma. Clin Nucl Med 2009; 34:625-7. [PMID: 19692831 DOI: 10.1097/rlu.0b013e3181b06c1a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 52-year-old man had a positron emission tomography computed tomography (PET-CT) scan for staging of a biopsy proven lung adenocarcinoma. An additional acquisition of the lower extremities was performed as the patient complained of bilateral leg pain. The PET-CT scan showed a 6.5 x 5.0 cm left upper lobe lung mass invading the mediastinum with maximal standardized uptake value of 10.7, compatible with primary lung cancer. The CT portion of the PET-CT of the legs showed extensive irregular bilateral periosteal new bone formation in the long bones. The PET images showed diffuse moderately increased FDG uptake in the periostea of the long bones of the legs, with some focal sites of more intense FDG uptake in the thicker portions of the periosteum. A bone scan showed mild hyperemia surrounding the long bones of the legs and intense Tc-99m MDP uptake in the periostea. The patient was diagnosed with hypertrophic pulmonary osteoarthropathy.
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Moreira JDS, Hass M, Moreira ALS, Fleck JDF, Camargo JDJP. Regressão do hipocratismo digital em pacientes com câncer de pulmão tratados cirurgicamente. J Bras Pneumol 2008; 34:481-9. [DOI: 10.1590/s1806-37132008000700008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2007] [Accepted: 09/24/2007] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Estudar, por meio de avaliações objetivas, a ocorrência de regressão do hipocratismo digital (HD) em pacientes com câncer de pulmão, tratados cirurgicamente, e revisar a literatura sobre o assunto. MÉTODOS: Sessenta e um pacientes com câncer de pulmão não-pequenas células-40 com e 21 sem HD-foram tratados por cirurgia de ressecção pulmonar. Onze deles (18%) também receberam radioterapia pós-operatória. No período pré-operatório e no 7º, no 18º e no 90º dia pós-operatório, o ângulo hiponiquial (AH) e a relação entre as espessuras falangeana distal e interfalangeana (EFD/EIF) foram determinados sobre imagens da sombra dos dedos indicadores em perfil. Uma revisão da literatura sobre regressão do HD (1954-2007) também foi efetuada. RESULTADOS: Do período pré-operatório ao 90º dia pós-operatório, o AH diminuiu de 200,5 ± 5,0º para 193,3 ± 6,8º (p < 0,001), e a relação EFD/EIF, de 1,014 ± 0,051 mm para 0,956 ± 0,045 mm (p < 0,001) no grupo de 40 pacientes com HD. Em 33 (82,5%), o AH e a relação EFD/EIF diminuíram, mas, em 7 (1,7%), 6 com evolução desfavorável, esses valores não se reduziram. Nos 21 pacientes sem HD, tanto o AH (184,5 ± 5,5º) como a relação EFD/EIF (0,937 ± 0,046 mm) permaneceram inalterados após a cirurgia. Na literatura (1954-2007) foram encontrados 52 casos em que a regressão do HD, observada em diversas condições clínicas, foi explicitamente referida, 5 dos quais eram casos de câncer de pulmão. CONCLUSÕES: O HD em pacientes com câncer de pulmão regride na maioria dos casos após tratamento cirúrgico efetivo do tumor, o que pode também ocorrer em pacientes com outras condições.
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Cosar-Alas R, Yurut-Caloglu V, Karagol H, Caloglu M, Yalcin O, Turgut B, Saynak M, Uzal C. Paraneoplastic syndrome of non-small cell lung carcinoma: A case with pancytopenia, leukocytoclastic vasculitis, and hypertrophic osteoarthropathy. Lung Cancer 2007; 56:455-8. [PMID: 17298855 DOI: 10.1016/j.lungcan.2007.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 12/26/2006] [Accepted: 01/10/2007] [Indexed: 11/24/2022]
Abstract
Various remote effects of cancer or paraneoplastic syndromes (PNS) are common in lung cancer, and may be the manifestation of the disease or its recurrence. The symptoms may be endocrine, neuromuscular or musculoskeletal, cardiovascular, cutaneous, hematologic, gastrointestinal, renal, or miscellaneous in nature. Since the symptoms of paraneoplastic syndromes may occur before the local symptoms of the primary tumor, it might be helpful in the early diagnosis of malignancy. We present a 65-year-old man with multiple paraneoplastic syndrome forms consisting of pancytopenia leukocytoclastic vasculitis and hypertrophic pulmonary osteoarthropathy, associated with non-small cell lung carcinoma.
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MESH Headings
- Aged
- Biopsy, Needle
- Carcinoma, Non-Small-Cell Lung/complications
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Diagnosis, Differential
- Fatal Outcome
- Follow-Up Studies
- Humans
- Lung Neoplasms/complications
- Lung Neoplasms/diagnosis
- Male
- Osteoarthropathy, Secondary Hypertrophic/diagnosis
- Osteoarthropathy, Secondary Hypertrophic/etiology
- Pancytopenia/diagnosis
- Pancytopenia/etiology
- Paraneoplastic Syndromes
- Tomography, X-Ray Computed
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
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Affiliation(s)
- Rusen Cosar-Alas
- Department of Radiation Oncology, Trakya University, Faculty of Medicine, 22030 Edirne, Turkey
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Kuhn G, Schultz M, Müller R, Rühli FJ. Diagnostic value of micro-CT in comparison with histology in the qualitative assessment of historical human postcranial bone pathologies. HOMO-JOURNAL OF COMPARATIVE HUMAN BIOLOGY 2007; 58:97-115. [PMID: 17451711 DOI: 10.1016/j.jchb.2006.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Accepted: 11/13/2006] [Indexed: 11/20/2022]
Abstract
Micro-computed tomography (muCT) is of great interest for palaeopathological examination because it is less invasive than histology. This study evaluates the diagnostic value of muCT for postcranial macerated bones. We investigated five specimens (osteomyelitis, tuberculosis, trauma, osteosarcoma and hypertrophic osteoarthropathy) of a pathology reference series by muCT and polarised light microscopy. The 3D muCT images allow an easy orientation within the specimen. Surface structures, thickness, continuity of the cortex and number, thickness and orientation of the trabeculae can be evaluated. The high number of muCT slices helps to choose the most interesting areas for further investigations. Grey value images display the degree of mineralisation. Yet, the differentiation between woven and lamellar bone is only possible using polarised light microscopy. muCT is a tool of high value for the examination of postcranial bone disorders. It cannot replace histological examinations completely because it cannot assess the bone quality (woven or lamellar). For the choice of the optimal location where slices for the microscopic investigation are later cut in heterogeneous samples, muCT is very useful. Therefore, we suggest performing the muCT examination first, followed by histology if necessary.
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Affiliation(s)
- G Kuhn
- Institute of Anatomy, University of Zurich, Winterthurerstrasse 190, CH-8057 Zürich, Switzerland
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Szekanecz E, András C, Sándor Z, Antal-Szalmás P, Szántó J, Tamási L, Kiss E, Szekanecz Z. Malignancies and soluble tumor antigens in rheumatic diseases. Autoimmun Rev 2006; 6:42-7. [PMID: 17110316 DOI: 10.1016/j.autrev.2006.03.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Paraneoplastic symptoms, caused by a malignancy, but not directly related to invasion by the tumor or its metastases are the result of a wide variety of tumor-derived biologic mediators like hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. There is some evidence that systemic inflammatory diseases, such as rheumatoid arthritis (RA), lupus, scleroderma or dermatomyositis may increase the risk for the development of malignancies, predominantly lymphoproliferative disorders. However, reports are somewhat controversial. Immunosuppressive and cytotoxic drugs used in antirheumatic therapy, such as methotrexate, cyclophosphamide, azathioprine or anti-TNF biologicals may also lead to the development of such tumors. Tumor-associated antigens may be produced by inflammatory cells and their production may be increased in RA and other autoimmune diseases.
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Affiliation(s)
- Eva Szekanecz
- Department of Oncology, University of Debrecen, Medical and Health Science Center, Móricz, Hungary.
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Silva L, Andreu JL, Muñoz P, Isasi C, López A. Hypertrophic osteoarthropathy associated with gastrointestinal stromal tumour. Ann Rheum Dis 2006; 65:681-2. [PMID: 16611866 PMCID: PMC1798127 DOI: 10.1136/ard.2005.044859] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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22
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Foster WK, Armstrong JA. Hypertrophic osteopathy associated with pulmonary Eikenella corrodens infection in a dog. J Am Vet Med Assoc 2006; 228:1366-9. [PMID: 16649940 DOI: 10.2460/javma.228.9.1366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 4-year-old English Pointer was examined because of chronic, progressive signs of pulmonary disease and failure to respond to medical treatment. CLINICAL FINDINGS At examination, radiography of the thorax revealed increased pulmonary opacity and air bronchograms in the right caudal lung lobe, and radiography of the forelimbs revealed periosteal bone production typical of hypertrophic osteopathy. Attempts to isolate a causative organism included bacterial culture of bronchoalveolar lavage fluid and a lung tissue specimen obtained via fine-needle aspiration. Despite a cytologic diagnosis of septic suppurative inflammation in the lavage fluid, those specimens did not yield bacterial growth. However, a biopsy specimen obtained during a lung lobectomy procedure yielded growth of Eikenella corrodens. TREATMENT AND OUTCOME Despite successful surgical removal of the consolidated lung lobe and initiation of antimicrobial treatment, the dog died 6 days after surgery. CLINICAL RELEVANCE The authors are not aware of reports of pulmonary infection with E. corrodens in animals. Infection with the organism is rare, but it is possible that infections are underreported given that the organism is difficult to culture and biopsy may be necessary to obtain enough tissue to yield a diagnosis.
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Affiliation(s)
- Wendy K Foster
- Department of Clinical Studies, Veterinary Teaching Hospital, Ontario Veterinary College, Guelph, ON N1G 2W1, Canada
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Ulusakarya A, Gumus Y, Brahimi N, Delmas-Marsalet B, Almohamad W, Misra SC, Goldschmidt E, Haydar M, Machover D. Symptoms in Cancer Patients and an Unusual Tumor. J Clin Oncol 2005; 23:9422-3. [PMID: 16361641 DOI: 10.1200/jco.2004.00.8474] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ayhan Ulusakarya
- Department of Hematology/Oncology, Paul Brousse Hospital, Villejuif, France
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András C, Csiki Z, Ponyi A, Illés A, Dankó K. Paraneoplastic rheumatic syndromes. Rheumatol Int 2005; 26:376-82. [PMID: 16091919 DOI: 10.1007/s00296-005-0005-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
Paraneoplastic symptoms caused by a malignancy but not directly related to tumour invasion are the result of a wide variety of tumour-derived biologic mediators, such as hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. On the other hand, the clinical severity of the symptoms can be used as a guide to the extent of response to underlying tumour therapy. The quality of life of the patient is affected, therefore the palliative treatment of paraneoplasia is very important.
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Affiliation(s)
- Csilla András
- Department of Oncology, University of Debrecen, Medical and Health Science Center, 4012, Debrecen, Nagyerdei krt. 98, Hungary
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