MRI diagnosis of hypertrophic osteoarthropathy from a remote childhood malignancy.
Hypertrophic osteoarthropathy (HOA) is a clinico-radiological syndrome characterized by digital clubbing, periosteal proliferation, bone pain, synovitis and arthralgia, all of these being commonly symmetrical. It is occasionally associated with nasopharyngeal lymphoepitheliomas and may develop before or after development of lung metastases in these patients. We report a case of a healthy 22-year-old female who presented to our institution with pain and swelling in the thighs and legs. She had a history of childhood nasopharyngeal lymphoepithelioma. Radiographs of the knees were negative. Magnetic resonance imaging (MRI) showed features suggestive of bilateral periostitis. Because of the propensity of the rare childhood nasopharyngeal lymphoepithelioma to present with HOA, this entity was included in the differential diagnosis. A subsequent chest radiograph and CT demonstrated a lung and mediastinal mass that were histologically confirmed to be metastatic. To the best of our knowledge, HOA and metastases from nasopharyngeal lymphoepithelioma occurring after such a long time interval have not been previously reported. Early demonstration and consideration of HOA on the basis of MRI, lead to expeditious and appropriate subsequent investigation.
Sainani
Nisha I
NI
Department of MRI, Mammography and BMD, Dr. Balabhai Nanavati Hospital & Research Centre, S.V. Road, Vile Parle (West), Mumbai 400 056, India, docnisainani@yahoo.co.in
Lawande
Malini A
MA
Parikh
Vipul P
VP
Pungavkar
Sona A
SA
Patkar
Deepak P
DP
Sase
Kirti S
KS
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary; D008214:Lymphocytes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008479:Mediastinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000473:pathology*; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents