MRI diagnosis of hypertrophic osteoarthropathy from a remote childhood malignancy

• Published in: Skeletal radiology 2007-06, Vol.36 (S1), p.S63-66
• Main Authors: SAINANI, Nisha I, LAWANDE, Malini A, PARIKH, Vipul P, PUNGAVKAR, Sona A, PATKAR, Deepak P, SASE, Kirti S
• Format: Article
• Language: English
• Subjects: Adult; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Diagnosis, Differential; Diseases of the osteoarticular system; Epithelial Cells - pathology; Female; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - drug therapy; Lung Neoplasms - secondary; Lymphocytes - pathology; Magnetic Resonance Imaging; Mediastinal Neoplasms - diagnosis; Mediastinal Neoplasms - drug therapy; Mediastinal Neoplasms - secondary; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Nasopharyngeal Neoplasms - complications; Nasopharyngeal Neoplasms - pathology; Osteoarthropathy, Secondary Hypertrophic - diagnosis; Osteoarthropathy, Secondary Hypertrophic - etiology; Osteoporosis. Osteomalacia. Paget disease; Otorhinolaryngology. Stomatology; Tomography, X-Ray Computed; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology
• ISSN: 0364-2348; 1432-2161
• DOI: 10.1007/s00256-006-0186-1

Hypertrophic osteoarthropathy (HOA) is a clinico-radiological syndrome characterized by digital clubbing, periosteal proliferation, bone pain, synovitis and arthralgia, all of these being commonly symmetrical. It is occasionally associated with nasopharyngeal lymphoepitheliomas and may develop before or after development of lung metastases in these patients. We report a case of a healthy 22-year-old female who presented to our institution with pain and swelling in the thighs and legs. She had a history of childhood nasopharyngeal lymphoepithelioma. Radiographs of the knees were negative. Magnetic resonance imaging (MRI) showed features suggestive of bilateral periostitis. Because of the propensity of the rare childhood nasopharyngeal lymphoepithelioma to present with HOA, this entity was included in the differential diagnosis. A subsequent chest radiograph and CT demonstrated a lung and mediastinal mass that were histologically confirmed to be metastatic. To the best of our knowledge, HOA and metastases from nasopharyngeal lymphoepithelioma occurring after such a long time interval have not been previously reported. Early demonstration and consideration of HOA on the basis of MRI, lead to expeditious and appropriate subsequent investigation.