HYPERTROPHIC PULMONARY OSTEOARTHROPATHY IN NASOPHARYNGEAL CARCINOMA -AN EARLY SIGN OF PULMONARY METASTASIS

The aims of this study were to determine the incidence of hypertrophic pulmonary osteoarthropathy (HPO) in nasoyharyngeal carcinoma (NPC) an d assess its clinical significance. Altogether, 407 NPC patients were reviewed retrospectively. HPO was identified by Tc-99(m)-methylene dip hosphonate bone scans and related clinical and radiographic evidence. Pulmonary metastases, bony metastases and titre of anti-Epstein Barr v irus (EBV) immunoglobulin were assessed in patients with and without H PO. The patients had a mean (+/-S.D.) age of 50.4 +/- 12.4 (range 17-7 3) years. HPO was found in 27 of the 407 (6.6%) NPC patients, among wh om 13 (48%) had pulmonary metastases. HPO preceded lung metastases by 7-22 months (14.4 +/- 6 months) in 7 (52%) patients. Six patients had overt lung metastases at the time of the bone scan. No significant dif ference was found in anti-EBV immunoglobulins between the patients wit h or without HPO, nor in the incidence of bony metastases between thes e two groups of patients. HPO should be regarded as an early sign of p ulmonary metastases.