症例３　70歳代　女性

肺性肥大性骨関節症 pulmonary hypertrophic osteoarthropathy

 

Physical examination ＆ Laboratory findings

digital clubbing
CEA↑（47.5）, SCC↑（4.9）

CT ＆ PET/CT

Bone scintigraphy

 

Diagnosis ：Hypertrophic pulmonary osteoarthropathy (HPO)  with lung cancer

 

Hypertrophic osteoarthropathy

・classified as either primary (3-5%) or secondary (pulmonary:HPO, pleural and diaphragm, cardiac, abdominal and others)
・characterized by the triad of periostitis, digital clubbing, painful swollen jointsAline Biral Zanon, et al. Bras J Rheumatol 49: 447-55, 2009

・involve diaphyses and metaphyses of long bones (tibia+fibula:75%, radius+ulna:80%, proximal phalanges:60%, femur:50%)
・related with elevated serum level of hormones and cytokines?
・improved by treatment of underlying diseases and medications (NSAIDs, steroids)Capelastegui A, et al. Clinical radiology 55: 72-75, 2000
Katsuhiko M, et al. Internal Medicine 40: 532-535, 2001

 

Differential diagnosis

・pachydermoperiostosis
・thyroid acropachy
・chronic venous stasis
・hypervitaminosis A

Donald Resnick, Mark J. Kransdorf. Bone and Joint Imaging 3^rd Edition. ELSEVIER SAUNDERS, Philadelphia, 2005, 1433-1438

 

Differential diagnosis

lung cancer : chemotherapy（CBDCA+PTX+BEV）　→　decreasing in size

initial exam	93th day

HPO : steroid　→　improvement of pain, swelling

 

Conclusion

HPO should be considered in a patient with lung cancer manifesting arthritis.

 

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参考文献

• Nisha I. Sainani, et al. MRI diagnosis of hypertrophic osteoarthropathy from a remote childhood malignancy. Skeletal Radiol
  36: S63-S66, 2007
  
• Meng-Yuan Tsai, et al. Hypertrophic pulmonary osteoarthropathy in a patient with lung cancer. Intern Med 53: 2757-2758,
  2014
  
• Aline Biral Zanon, et al. Primary hypertrophic osteoarthropathy: case report and literature review. Bras J Rheumatol 49:
  447-55, 2009
  
  

 

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