Secondary hypertrophic osteoarthropathy caused by non-pleural or pulmonary tumors

Our plain-English summary of Secondary hypertrophic osteoarthropathy caused by non-pleural or pulmonary tumors, by H.J. Meyer, L. Leifels, A.G. Bach, et al (Medicine, 2017).

The study

• Authors: H.J. Meyer, L. Leifels, A.G. Bach, A. Surov
• Journal: Medicine
• Published: 2017;96(36):e7985
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Hypertrophic osteoarthropathy (HOA) is a rare paraneoplastic syndrome characterized by digital clubbing, periosteal reaction, polyarthralgia, arthritis, and synovitis. Herein, we report a case series of patients with secondary HOA caused by non-pleural or pulmonary tumors.The radiologic databases of 2 tertiary university hospitals were retrospectively screened for secondary HOA patients. In addition, a systemic review of the published case reports. Only HOA cases with non-pleural or pulmonary malignancies were involved into the study. HOA in primary pleural or pulmonary malignant or benign disorders, as well in inflammatory diseases were excluded. In all cases, plain radiography was performed and clinical signs were documented.In our databases, 6 patients with secondary HOA were identified. In addition, the systemic review yielded 24 eligible patients. The most prevalent primary tumors were nasopharyngeal carcinoma and esophageal cancer in 6 patients (20%), respectively. In 17 patients, (56.7%) HOA was associated with lung metastases, and in 10 patients (33.3%), no lung metastases were detected. In 14 patients (46.7%), HOA was symptomatically before a tumor diagnosis was made. Plain radiography displayed typically features with periostal enlargement in every case.This study is the first report about secondary HOA caused by non-pleural or pulmonary tumors. Various primary tumors were identified, including several rare tumors such as sarcomas. HOA is a rare disorder with typically radiologically findings, which is not only associated with lung cancer or pleural mesothelioma and can even occur in tumor patients without lung metastasis.

In plain English

This study looked at hypertrophic osteoarthropathy (HOA), a rare condition involving finger clubbing, joint and bone pain, and thickening of the outer layer of the long bones, in patients whose primary tumors were not lung or pleural tumors. The article does not report on asbestos exposure. The authors combined 6 patients found in the radiology records of two university hospitals with 24 previously published cases, for 30 patients (18 male, 12 female) aged 16 to 73 years. The most common tumors were nasopharyngeal carcinoma and esophageal cancer, 6 patients (20%) each. HOA occurred with lung metastases in 17 patients (56.7%) and without lung metastases in 10 (33.3%). In 14 patients (46.7%), HOA symptoms appeared before the tumor was diagnosed. Plain X-rays showed the bone-surface reaction in every patient. The authors concluded that HOA is not only associated with lung cancer or pleural mesothelioma. They noted that the study was retrospective and small, could not measure how common HOA is in different tumors, and may be affected by publication bias.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series from hospital radiology databases, combined with a systematic review of published case reports
• Who was studied: 30 patients with HOA caused by primary tumors other than lung or pleural tumors; some of these patients had tumors that had spread to the lungs. Six came from the radiology databases of 2 tertiary university hospitals. Twenty-four came from 23 English- or German-language reports published January 1996 to April 2017. The authors stated that their aim was to study adult patients and that pediatric patients were excluded, but the reported age range was 16 to 73 years. There were 18 males and 12 females, with a mean age of 43.9 years (plus or minus 15.5).
• Exposure: Not studied. The article reports no asbestos or other exposure; it concerns HOA in patients whose primary tumors were not lung or pleural tumors.
• Main results:
  • The most frequent tumors among the 30 patients were nasopharyngeal carcinoma and esophageal cancer, 6 patients (20%) each.
  • HOA was associated with lung metastasis in 17 patients (56.7%), and no lung metastasis was detected in 10 patients (33.3%). The remaining 3 patients (10%) had lymphomas located in the chest.
  • Most patients (27, 90%) presented with arthralgia and bone pain.
  • In 14 patients (46.7%), HOA symptoms were detected before a tumor diagnosis was made.
  • A periosteal reaction of the long bones was seen on plain radiography in all patients.
  • In 11 patients (36.7%), HOA symptoms regressed after tumor treatment.
• The authors' conclusion: The authors concluded that HOA is not only associated with lung cancer or pleural mesothelioma but also occurs with other tumors, both with and without lung metastasis.
• Limitations the authors state:
  • The study is a retrospective case study.
  • The patient sample is small because the condition is rare.
  • The study cannot give the real prevalence of secondary HOA in different primary tumors.
  • Publication bias is possible, because only clinically noticeable cases get published as case reports and some cases without symptoms may never be diagnosed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Clubbing, Carcinoma, Esophageal Cancer, Sarcoma, Lung Cancer, Pleural Mesothelioma, Metastasis.

Related studies

• Hypertrophic osteoarthropathy in childhood malignancy — C.R. Staalman, U. Umans (1993)
• Finger clubbing in malignant mesothelioma and benign asbestos pleural disease — C. McGavin, P. Hughes (1998)
• Interval between cytoreductions as a marker of tumor biology in selecting patients for repeat cytoreductive surgery with hyperthermic intraperitoneal chemotherapy — I.T. Konstantinidis, E.A. Levine, et al. (2017)
• Pulmonary toxicity and translocation of gallium phosphide nanowires to secondary organs following pulmonary exposure in mice — T. Berthing, M. Lard, et al. (2023)
• Bilateral diffuse pulmonary infiltrates secondary to malignant peritoneal mesothelioma - A rare clinical presentation — M. Haygarth, K.K. Zaw, et al. (2019)
• Mesotheliomas and secondary tumors of the pleura — K. Ellis, M. Wolff (1977)

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