RESUMEN
Hypertrophic pulmonary osteoarthropathy (HPOA), mainly manifested clubbing, is rare in patients with esophageal sarcomatoid carcinoma. We herein describe a 48-year-old Chinese man whose advanced sarcomatoid carcinoma was diagnosed while examining his symptoms of HPOA. The patient had no opportunity of surgery after surgical evaluation. Chemoradiation, including 5 cycles of chemotherapy (Paclitaxel liposome 60 mg day 1 and nedaplatin 30 mg day 1, q1w) and 6MV-X/VMAT-95%PGTV 59.92 Gy/2.14 Gy/28 F and 95%PTV 50.4 Gy/1.8 Gy/28 F, and subsequent 6 cycles of chemotherapy (paclitaxel liposome 210 mg day 1 and nedaplatin 50 mg day 1, 60 mg day 2, q3w) shrank the tumor and the condition of the patient became stable without clubbing remission or exacerbation. No medical case report found in a PubMed search in the indexed English-language literature in the past 20 years, though there are some reports of HPOA combined with other pathologic types of esophageal carcinoma. The patient's condition was effectively controlled by chemotherapy and radiotherapy and showed stable disease. However, the five-year survival rate of advanced esophageal carcinoma patients is very low with low life quality, and the adverse reactions also contribute to low life quality. The purpose of this report is to present the feature and our treatment for primary esophageal sarcomatoid carcinoma with HPOA, which could be helpful for further understanding of the disease and clinical decision making. Moreover, this article also reviews esophageal carcinoma with HPOA and sarcomatoid carcinoma in the esophagus. We look forward to the breakthrough of immunotherapy and molecular targeting therapy to improve the situation.
Asunto(s)
Carcinoma , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Osteoartropatía Hipertrófica Secundaria , Quimioradioterapia , Neoplasias Esofágicas/terapia , Humanos , Masculino , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológicoAsunto(s)
Dolor en Cáncer/prevención & control , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Dolor en Cáncer/etiología , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/patología , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/complicaciones , Osteoartropatía Hipertrófica Secundaria/patología , PronósticoRESUMEN
Hypertrophic pulmonary osteoarthropathy (HPO) is a paraneoplastic syndrome characterized by digital clubbing, arthritis, and periostitis. Tumor removal usually leads to the resolution of these symptoms. We herein report the efficacy of crizotinib treatment for treating the symptoms of HPO associated with c-ros oncogene 1 receptor tyrosine kinase (ROS1)-rearranged lung cancer. A 71-year-old woman presented with a pulmonary tumor and arthritis. She was diagnosed with a ROS1-rearranged lung adenocarcinoma [stage IIIB (cT4N2M0) ] with HPO. Crizotinib dramatically reduced the tumor size and resolved the symptoms. After two months of crizotinib treatment, she underwent lobectomy, and a pathological evaluation revealed ypstage IIIA (ypT3a, ypN1). Crizotinib treatment was effective for reducing the tumor size and improving the symptoms of HPO.
Asunto(s)
Adenocarcinoma del Pulmón/tratamiento farmacológico , Adenocarcinoma del Pulmón/patología , Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/patología , Crizotinib/uso terapéutico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/etiología , Proteínas Tirosina Quinasas/efectos de los fármacos , Proteínas Proto-Oncogénicas/efectos de los fármacos , Adenocarcinoma del Pulmón/diagnóstico , Anciano , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Femenino , Humanos , Resultado del TratamientoAsunto(s)
Hemangiosarcoma/complicaciones , Neoplasias Hepáticas/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Adulto , Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Biopsia , Resultado Fatal , Hemangiosarcoma/diagnóstico por imagen , Hemangiosarcoma/secundario , Hemangiosarcoma/cirugía , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/cirugía , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
Chumbley EM. You're the flight surgeon: a case of bilateral leg pain and swelling in a loadmaster. Aerosp Med Hum Perform. 2017; 88(5):511-515.
Asunto(s)
Adenocarcinoma/complicaciones , Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/terapia , Adulto , Conservadores de la Densidad Ósea/uso terapéutico , Quimioterapia Adyuvante , Difosfonatos/uso terapéutico , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/terapia , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Pamidronato , Neumonectomía , Tomografía Computarizada por Rayos XAsunto(s)
Peroné/patología , Neoplasias Pulmonares/diagnóstico , Pulmón/patología , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Tibia/patología , Tomografía Computarizada por Rayos X , Anciano , Analgesia , Disnea , Peroné/diagnóstico por imagen , Humanos , Pulmón/diagnóstico por imagen , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Cuidados Paliativos , Radiografía Torácica , Esputo , Tibia/diagnóstico por imagen , Pérdida de Peso , Imagen de Cuerpo EnteroRESUMEN
We describe a case of 23-year-old man, who presented with painful hypertrophic pulmonary osteoarthropathy involving bilateral upper and lower extremities, resulting from intrathoracic metastasis. The patient had a history of undifferentiated nasopharyngeal carcinoma which was treated successfully 2 years ago. The painful osteoarthropathy had made the patient incapacitated. A single dose of 4 mg of intravenous zoledronic acid (ZA) was given which resulted in complete resolution of pain along with reduction of swelling. There was no recurrence on follow-up. Bisphosphonates by their action on bone metabolism might alleviate the symptoms and its use should be encouraged in cancer patients with debilitating arthropathies. This article aims at highlighting the role of bisphosphonates, particularly ZA in managing patients with hypertrophic osteoarthropathy (HOA) and sharing our experience with this drug because of the rarity of the condition and lack of sufficient data in the medical literature.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Imidazoles/uso terapéutico , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Neoplasias Nasofaríngeas/secundario , Neoplasias Nasofaríngeas/terapia , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Adulto , Carcinoma , Diagnóstico Diferencial , Humanos , Infusiones Intravenosas , Neoplasias Pulmonares/patología , Metástasis Linfática/patología , Masculino , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/patología , Estadificación de Neoplasias , Cuidados Paliativos , Tomografía Computarizada por Rayos X , Ácido ZoledrónicoAsunto(s)
Antibacterianos/uso terapéutico , Disentería Amebiana , Peroné/diagnóstico por imagen , Osteoartropatía Hipertrófica Secundaria , Sulfasalazina/uso terapéutico , Tibia/diagnóstico por imagen , Adulto , Amebicidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Colonoscopía/métodos , Disentería Amebiana/complicaciones , Disentería Amebiana/diagnóstico , Disentería Amebiana/tratamiento farmacológico , Disentería Amebiana/fisiopatología , Entamoeba histolytica/aislamiento & purificación , Humanos , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/etiología , Osteoartropatía Hipertrófica Secundaria/fisiopatología , Radiografía , Resultado del TratamientoRESUMEN
Hypertrophic osteoarthropathy is an entity characterized by a triad of periostitis of long bones, clubbing and arthritis. Radiologically there are two patterns, one characterized by new bone formation which predominates in patients with pulmonary disease, and another by acro-osteolysis that is most frequently associated with congenital heart disease. We report the case of a 30-year-old man diagnosed with primary pulmonary hypertension for two years, developing hypertrophic osteoarthropathy with a mixed radiological pattern.
Asunto(s)
Hipertensión Pulmonar/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Adulto , Autoanticuerpos/sangre , Autoantígenos/inmunología , Calcio/uso terapéutico , Citrulina/análisis , Difosfonatos/uso terapéutico , Huesos de la Mano/diagnóstico por imagen , Humanos , Imidazoles/uso terapéutico , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico por imagen , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Péptidos/química , Péptidos/inmunología , Pregnenodionas/uso terapéutico , Radiografía , Radio (Anatomía)/diagnóstico por imagen , Vitamina D/uso terapéutico , Articulación de la Muñeca/diagnóstico por imagen , Ácido ZoledrónicoRESUMEN
Hypertrophic pulmonary osteoarthropathy (HOA) is a condition associated with lung cancer and many other diseases. Pain associated with HOA can be disabling, unremitting, and refractory to conventional analgesic medications. We present a challenging case of HOA in a patient with nonsmall cell lung cancer and review specific therapies for management of HOA-related pain.
Asunto(s)
Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/complicaciones , Manejo del Dolor/métodos , Dolor/prevención & control , Cuidados Paliativos/métodos , Humanos , Masculino , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Dolor/etiologíaAsunto(s)
Adenocarcinoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Femenino , Fiebre , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/cirugía , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/cirugía , Medicina TropicalRESUMEN
OBJECTIVES: Zoledronic acid (ZA) is rarely used to manage hypertrophic osteoarthropathy (HOA). We report our experience with ZA treatment of a patient with HOA and sarcoidosis who had also undergone lung transplant. We also conducted a literature review of the usefulness of bisphosphonates in HOA. METHODS: We performed a PubMed literature search using keywords HOA, periostitis, bisphosphonate, ZA, sarcoidosis, and lung transplant. A PRISMA flow diagram is presented to depict the data collection process, and a case is reported. RESULTS: A 62-year-old woman with bilateral lung transplant as a result of severe pulmonary sarcoidosis developed severe limb pain and inflammatory polyarthritis. HOA was diagnosed in the presence of periostitis with the symptoms. Failure of the refractory bone and joint pain to respond to low doses of prednisone, tramadol, or even pamidronate infusion prompted a trial of a single dose of intravenous ZA. Surprisingly, the pain completely resolved without recurrence. A total of 12 cases of HOA treated with bisphosphonates were retrieved from the literature and reviewed. CONCLUSIONS: Bisphosphonates are generally effective therapy for HOA-related pain. ZA may be even more efficacious and longer lasting than pamidronate for management of the bone and joint pain associated with HOA irrespective of the underlying disorders.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Imidazoles/uso terapéutico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Sarcoidosis/complicaciones , Femenino , Humanos , Trasplante de Pulmón , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/etiología , Sarcoidosis/cirugía , Resultado del Tratamiento , Ácido ZoledrónicoRESUMEN
INTRODUCTION: The authors report two cases of young patients who developed clubbing and hypertrophic osteoarthropathy in one case or lung diffusion disorder in the second, after a long-term use of bevacizumab plus chemotherapy in a palliative setting of metastatic colorectal cancer. DISCUSSION: We propose that patients on long-term bevacizumab be examined for clubbing and undergo respiratory function tests and that this would be studied prospectively before beginning trials in evaluating this monoclonal antibody given for 2 years in an adjuvant setting.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/inducido químicamente , Adulto , Bevacizumab , Camptotecina/efectos adversos , Camptotecina/análogos & derivados , Femenino , Fluorouracilo/efectos adversos , Humanos , Leucovorina/efectos adversos , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Hypertrophic osteoarthropathy (HOA) is a syndrome most commonly associated with non-small cell lung cancer and consists of periostitis, digital clubbing and painful polyarthropathy. Its symptoms may be disabling and are reportedly difficult to manage effectively with conventional analgesia. We present a case of a lung cancer patient with opioid resistant painful HOA in whom analgesia was achieved with octreotide.
Asunto(s)
Adenocarcinoma/complicaciones , Antineoplásicos Hormonales/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Neoplasias Pulmonares/complicaciones , Octreótido/uso terapéutico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Dolor/tratamiento farmacológico , Anciano , Humanos , Masculino , Osteoartropatía Hipertrófica Secundaria/etiología , Dolor/etiologíaRESUMEN
We report 3 patients with periosteal new bone formation consistent with hypertrophic osteoarthropathy (HOA), in the context of intestinal allograft rejection. Patient 1 developed thick periosteal new bone formation of the right arm during a prolonged episode of intestinal acute cellular rejection (ACR) 2 months posttransplant. Patient 2 developed ankle pain and swelling during an episode of severe ACR. Plain films showed periosteal new bone formation of the left ankle. In patient 3, the right wrist became swollen during an episode of moderate ACR, whereas plain films demonstrated mild periosteal reaction. Patients 2 and 3 had resolution of their symptoms once the ACR resolved with treatment. This is the first case series of HOA occurring in association with intestinal ACR. We speculate that an immune-mediated process is responsible for the bone disease. Further inquiry will help establish if HOA is related to transplant status, intestinal inflammation, or allograft rejection in general.
Asunto(s)
Rechazo de Injerto/complicaciones , Intestino Delgado/trasplante , Trasplante de Órganos/efectos adversos , Osteoartropatía Hipertrófica Secundaria/etiología , Enfermedad Aguda , Preescolar , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/tratamiento farmacológico , Humanos , Inmunosupresores/uso terapéutico , Lactante , Enfermedades Intestinales/cirugía , Masculino , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Adulto JovenRESUMEN
A 32-year old female patient with Graves' disease was diagnosed with pretibial myxedema. It is part of the triad of extrathyreoidal manifestations of Graves' disease: exophthalmia, pretibial myxedema, and acropachy. The patient was successfully treated with topical corticosteroids.
Asunto(s)
Exoftalmia/diagnóstico , Enfermedad de Graves/complicaciones , Dermatosis de la Pierna/diagnóstico , Mixedema/diagnóstico , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Adulto , Exoftalmia/tratamiento farmacológico , Exoftalmia/etiología , Femenino , Humanos , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/etiología , Mixedema/tratamiento farmacológico , Mixedema/etiología , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Osteoartropatía Hipertrófica Secundaria/etiología , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
Hypertrophic osteoarthropathy (HOA) is characterized by clubbing of digits and, in more advanced stages, by periosteal new bone formation and synovial effusions. Secondary HOA typically occurs in the setting of intrathoracic malignancy, infections or lung metastases. We report a case with an atypical presentation of HOA. The prominent systemic signs, presentation limited to lower extremities only and an excellent response to bisphosphonates make this case unusual.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Celulitis (Flemón)/diagnóstico , Difosfonatos/uso terapéutico , Extremidad Inferior , Osteoartropatía Hipertrófica Secundaria/diagnóstico , Adulto , Celulitis (Flemón)/tratamiento farmacológico , Diagnóstico Diferencial , Humanos , Masculino , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Hypertrophic osteoarthropathy (HOA) is a syndrome characterized by digital clubbing, arthralgias, and tissue swelling and is frequently described in association with bronchogenic carcinoma. The associated pain can be disabling, and symptoms are often resistant to conventional analgesic medications. We present a patient with HOA of the lower extremities and wrists that developed after bronchogenic carcinoma. The pain and swelling completely resolved after a single administration of 4 mg of zoledronic acid. The proposed pathogenesis of HOA and the mechanisms by which bisphosphonates might alleviate symptoms are reviewed.
Asunto(s)
Conservadores de la Densidad Ósea/uso terapéutico , Difosfonatos/uso terapéutico , Imidazoles/uso terapéutico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológico , Carcinoma Broncogénico/complicaciones , Femenino , Humanos , Neoplasias Pulmonares/complicaciones , Persona de Mediana Edad , Osteoartropatía Hipertrófica Secundaria/etiología , Osteoartropatía Hipertrófica Secundaria/fisiopatología , Ácido ZoledrónicoAsunto(s)
Artroplastia de Reemplazo de Rodilla , Carcinoma de Células Pequeñas/complicaciones , Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Complicaciones Posoperatorias , Anciano , Antiinflamatorios no Esteroideos/uso terapéutico , Femenino , Humanos , Indometacina/uso terapéutico , Osteoartropatía Hipertrófica Secundaria/tratamiento farmacológicoRESUMEN
The patient was a 39-year-old woman admitted with complaints of fever, clubbed fingers and arthralgia. A chest roentgenogram and chest computed tomographic scan revealed a mass in the left lower lobe. Transbronchial lung biopsy was performed, and a diagnosis of moderately differentiated adenocarcinoma was made. Physical examination confirmed finger clubbing in both hands. Bone scintigram showed marked accumulation of 99mTc-MDP in the long bones, bones of the elbows, and patellae. These findings yielded a diagnosis of pulmonary hypertrophic osteoarthropathy associated with primary lung cancer in young adult. The patient had fever and disturbance of gait of arthralgia on admission, and was treated with an oral non-steroidal anti-inflammation drug (NSAID). Advanced non small cell lung cancer (clinical stage T2 N3 M1, Stage IV) was then diagnosed. Gefitinib was administered after EGFR mutation was found in the tumor specimen. NSAID therapy alleviated the fever and arthralgia. After starting gefitinib and discontinuing the NSAID, She had kept a remission of rational symptom with cytoreductive effect. The abnormal findings of bone scintigrams subsequently disappeared and the patient's serum ICTP dropped.