Wang C J, Huang C H, Leung S W, Chen H C, Huang E Y
Department of Radiation Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
Changgeng Yi Xue Za Zhi. 1998 Jun;21(2):222-6.
Hypertrophic osteoarthropathy (HOA) is a rheumatic disorder characterized by digital clubbing, bone pain, and arthralgia. HOA can be idiopathic or secondary to a variety of pulmonary, cardiogenic, or malignant disorders. We present 2 male patients, aged 46 and 42, with advanced nasopharyngeal carcinoma (NPC) who developed HOA 1-4 years after radiotherapy. Differential diagnosis between HOA and coexisting bone metastasis must be made with caution. We found bone scintigraphy to be the most sensitive tool to distinguish between these 2 disease. Intense symmetrical uptake of radioisotope along the cortex of long bones, so-called parallel tract sign, is typical. Plain radiographs demonstrating prominent periosteal reaction were also effective for this. The rheumatic manifestation of HOA was paraneoplastic and related to pulmonary metastasis. The clinical manifestation of the 2 patients suggested that pulmonary metastasis should be suspected in NPC patients when HOA appears.
肥大性骨关节病（HOA）是一种以杵状指、骨痛和关节痛为特征的风湿性疾病。HOA可以是特发性的，也可以继发于多种肺部、心源性或恶性疾病。我们报告了2例年龄分别为46岁和42岁的男性晚期鼻咽癌（NPC）患者，他们在放疗后1 - 4年出现了HOA。必须谨慎地对HOA和并存的骨转移进行鉴别诊断。我们发现骨闪烁显像术是区分这两种疾病最敏感的工具。放射性核素沿长骨皮质呈强烈对称性摄取，即所谓的平行束征，这是典型表现。显示明显骨膜反应的X线平片对此也有效。HOA的风湿性表现是副肿瘤性的，且与肺转移有关。这2例患者的临床表现提示，NPC患者出现HOA时应怀疑有肺转移。
