HYPERTROPHIC OSTEOARTHROPATHY IN CHILDHOOD MALIGNANCY

Hypertrophic osteoarthropathy (HOA), well known in adults, is rarely e ncountered in children. The clinical features include clubbing of the fingers and toes, arthritis, and a sometimes painful ossifying periost itis of the tubular bones. Apart from a hereditary form (primary HOA), most of the cases encountered in children are secondary and associate d with conditions such as chronic suppurative lung processes (e.g., cy stic fibrosis), congenital heart disease, biliary atresia, and polypos is coli. The association with malignant disorders, which is relatively common in adults, is very rare in children. In 1986 the authors publi shed a case report of a patient with carcinoma of the nasopharynx who developed HOA. Another similar patient has been encountered. In both, the appearance of HOA was associated with a very poor prognosis. A met iculous research of the literature from 1890 to 1990 revealed only 24 children (19 boys, 5 girls) under the age of 18, with malignancy and a ssociated HOA. Among them were 10 patients with a carcinoma of the nas opharynx, 8 with osteosarcoma, 3 with Hodgkin's lymphoma, 1 with a per iosteal sarcoma, 1 with mesothelioma of the pleura, and 1 with carcino ma of the thymus. In five patients with HOA, there were no abnormaliti es of the lungs, mediastinum, or pleura, and none developed during the course of the disease. Many authors mention the predictive value of H OA, especially in association with malignant tumors. In contrast to su ppurative processes in the lungs, in those with neoplastic disease inv olving the chest, HOA may precede pulmonary symptoms by 1-18 months. A striking feature of HOA in these instances is the reversibility of th e complaints after successful treatment of the disorder of the chest, both in benign and malignant conditions. The present case is the secon d reported by the authors and the first description of a girl with car cinoma of the nasopharynx developing HOA. (C) 1993 Wiley-Liss, Inc.