Hypertrophic osteoarthropathy pathogenesis: a case highlighting the potential role for cyclo-oxygenase-2-derived prostaglandin E2.
BACKGROUND
A 65-year-old woman presented with weakness, 9 kg weight loss, dysphagia, facial and bilateral upper-extremity swelling, and debilitating, bilateral lower-extremity pain. The patient had undergone a right upper lobectomy for a 5 mm, poorly differentiated adenocarcinoma of the lung 4 years previously. Medical history included chronic obstructive pulmonary disease (emphysema), hypertension, cerebrovascular disease and multinodular goiter. Surgical history included a right carotid endarterectomy. The patient's history was remarkable for 50+ pack-years of smoking.


METHODS
Physical examination, comprehensive metabolic panel and complete blood counts, CT, bone scintigraphy, quantification of urinary 11a-hydroxy-9,15-dioxo-2,3,4,5-tetranor-prostane-1,20-dioic acid (also known as PGE-M).


METHODS
Recurrent non-small-cell lung cancer with adrenal metastasis, hypertrophic osteoarthropathy associated with non-small-cell lung cancer, and hyperprostaglandinuria.


RESULTS
Rofecoxib 25 mg daily for hypertrophic osteoarthropathy, palliative external-beam radiation (44 Gy in 22 fractions) for mediastinal mass, palliative external-beam radiation (30 Gy in 12 fractions), followed 2 years later with radiofrequency ablation, for left adrenal metastasis.
Kozak
Kevin R
KR
Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, MA 02114, USA. kkozak@partners.org
Milne
Ginger L
GL
Morrow
Jason D
JD
Cuiffo
Barry P
BP
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000378:metabolism / Q000628:therapy; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D015232:Dinoprostone / Q000378:metabolism*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000150:complications / Q000378:metabolism / Q000628:therapy; D008565:Membrane Proteins / Q000378:metabolism*; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D013450:Sulfones / Q000627:therapeutic use
D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D008565:Membrane Proteins; D013450:Sulfones; C116926:rofecoxib; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D015232:Dinoprostone