key: cord-0005711-8s7om2pm
authors: Sugimoto, Hiroshi; Nakata, Kyosuke
title: Hypertrophic pulmonary osteoarthropathy: an unusual manifestation of lung cancer
date: 2020-03-14
journal: QJM
DOI: 10.1093/qjmed/hcaa093
sha: b5b0e5fbc3740ac42638eac8c5c9bd6e54b1a8b8
doc_id: 5711
cord_uid: 8s7om2pm

nan

A 71-year-old Japanese man presented to our hospital with a 2-month history of swelling and pain in his bilateral hands, knees, and ankles and a 1-month history of left back pain. He was a current smoker with a 50-pack-year history of tobacco use and had no remarkable medical history. His vital signs were within the normal ranges, and physical examination revealed mild digital clubbing ( Figure 1A) . Chest radiography revealed a mass in the left upper lobe.

We performed a biopsy of the mass using endobronchial ultrasonography with a guide sheath and then made a diagnosis of lung adenocarcinoma. Furthermore, whole-body bone scintigraphy revealed increased uptake along the tibias, a typical finding of hypertrophic pulmonary osteoarthropathy ( Figure 1B ). His lung cancer was operable, but he desired only best supportive care.

Hypertrophic pulmonary osteoarthropathy (HPO), also known as Bamberger-Marie syndrome, is a condition characterized by the triad of digital clubbing, periostitis of the long bones, and arthropathy [1] . This syndrome is often associated with malignancy, especially lung cancer, and some known risk factors such as male sex, smoking history, adenocarcinoma, and advancedstage cancer [1] . Although the pathogenic process in HPO is not fully understood, the involvement with elevated growth factors such as vascular endothelial growth factor has been 3 reported [1] .

Whole-body bone scintigraphy is considered a diagnostic examination and shows symmetrical increased periosteal uptake in the long bones [2] , as observed in our patient. This typical finding can be a clue to distinguish HPO and bone metastasis. Treatments for HPO include therapies for the underlying disease; [3] however, our patient declined the treatment for lung cancer.

https://mc.manuscriptcentral.com/qjm 

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