Fietz T, Schneider P, Knauf W U, Thiel E
Medizinische Klinik III, Universitätsklinikum Benjamin Franklin, Freie Universität, Berlin.
Dtsch Med Wochenschr. 1998 Dec 11;123(50):1507-11. doi: 10.1055/s-2007-1024216.
During chemotherapy for a non-small-cell bronchial carcinoma with metastasis to the right femur (previously locally excised), a 34-year-old man suddenly developed severe, lasting joint pain in the ankle, knee, elbow and wrist without signs of increased warmth or swelling of these joints. At the time of diagnosis clubbed fingers had been noted.
Radiography of the hands showed bilateral periosteal hyperostoses. Computed tomography of the thorax revealed tumor progression.
DIAGNOSIS, TREATMENT AND COURSE: The triad of clubbed fingers, periosteal hyperostoses and arthralgia/arthritis with the pulmonary findings established the diagnosis of hypertrophic pulmonary osteoarthritis (HPO; Marie-Bamberger syndrome). Initially there had merely been the signs of the much more frequent incomplete form with only the clubbed fingers, the complete form developing with progression of the disease during chemotherapy, joint pains dominating the symptoms. After right upper lobectomy (primary adenocarcinoma) the joint pains ceased and the finger clubbing regressed.
Only 10% of non-small-cell bronchial carcinomas are associated with HPO. Conversely, such a tumor is found in 90% of HPO of recent onset and should therefore be sought of when searching for the primary tumor. The signs of HPO are reversible if the underlying disease is adequately treated.
一名34岁男性在接受非小细胞支气管癌化疗（该肿瘤已转移至右股骨，此前已局部切除）期间，突然出现踝关节、膝关节、肘关节和腕关节严重且持续的关节疼痛，这些关节无发热或肿胀加剧迹象。诊断时发现有杵状指。
手部X线显示双侧骨膜增生。胸部计算机断层扫描显示肿瘤进展。
诊断、治疗与病程：杵状指、骨膜增生以及关节痛/关节炎三联征与肺部表现共同确立了肥厚性肺性骨关节病（HPO；Marie - Bamberger综合征）的诊断。最初仅出现更为常见的不完全形式的体征，仅有杵状指，在化疗期间随着疾病进展发展为完全形式，关节疼痛成为主要症状。右上叶切除术后（原发性腺癌）关节疼痛停止，杵状指消退。
仅10%的非小细胞支气管癌与HPO相关。相反，在90%的近期发病的HPO病例中可发现此类肿瘤，因此在寻找原发肿瘤时应予以排查。如果基础疾病得到充分治疗，HPO的体征是可逆的。
