Pierre Marie-Bamberger syndrome (secondary hypertrophic osteoarthropathy)

Pierre-Marie Bamberger Syndrome Leading to the Diagnosis and Surgical Treatment of a Localized Lung Cancer

Hypertrophic osteoarthropathy (HOA), manifested with digital clubbing, tubular bone periostosis, and large joint synovial effusions, exists in two forms: primary, which is the rarest form, and secondary. The latter is frequently associated with lung diseases and, in some cases, with non-small cell lung cancer (NSCLC) and is thus expressed in the form of a paraneoplastic syndrome. We report the case of a male smoker who was presented with secondary hypertrophic osteoarthropathy and was subsequently diagnosed with primary adenocarcinoma of the lung. A 63-year-old male with a history of ischemic heart disease and heavy tobacco consumption (60 pack-years) presented with painful osteoarthritis of all four extremities. A chest computed tomography (CT), a positron emission tomography (PET) scan, and a bronchoscopy revealed a 9 cm mass within the right lower lobe without mediastinal adenopathy. Bilateral lower limb X-rays revealed osteoarthropathy of the tibia. A right lower lobectomy and mediastinal lymph node dissection were performed. Final histopathology analysis reported an advanced mixed pulmonary adenocarcinoma. The postoperative course was uneventful and the patient was discharged on postoperative day 6. This report has highlighted the importance of clinical awareness of the association between HOA and carcinoma of the lung.

Nociceptive pain unmasking a serious pathology - paraneoplastic hypertrophic osteoarthropathy: A case report

RATIONALE

Hypertrophic osteoarthropathy, also named Pierre Marie-Bamberger syndrome, represents a rare medical condition that may be considered either a primary or a secondary disease, and lung malignancies are responsible for more than two-thirds of the cases with secondary forms of the disease.

PATIENT CONCERNS

We present the case of a 41-year-old man referred to our Neurology Department for pain that was considered secondary to cervical disc protrusions. The neurologic examination was normal. However, the general examination showed digital clubbing, right lateral cervical adenopathy, and pachydermia. The radiographic examinations of the upper and lower limbs depicted osseous abnormalities typical for periostosis, and the computed tomography of the thorax showed the presence of a mass lesion in the right upper pulmonary lobe. High values of vascular endothelial growth factor were also found. The patient was admitted to the Pneumology Clinic, where biopsy was performed from the lateral cervical adenopathy.

DIAGNOSES

The anatomopathological examination revealed multiple neoplastic infiltrates suggestive of adenocarcinoma metastasis. Based on the clinical examination and radiological and histologic findings, the diagnosis of pulmonary adenocarcinoma with lymph nodes metastases and paraneoplastic hypertrophic osteoarthropathy was established.

INTERVENTIONS

The patient received treatment with nonsteroidal antiinflammatory drugs and opiate analgesics that relieved the pain.

OUTCOMES

The patient was referred to the Oncology Department for further treatment of the primary pathology. He received different types of chemotherapeutics, immunotherapy, and radiotherapy. However, despite all therapeutic measures, the disease rapidly progressed and the patient died 9 months later.

LESSONS

This is an interesting case of a patient with an overlooked pathology, which was refereed to our clinic for further investigations of a pain that was considered neuropathic, secondary to small cervical protrusions. Conversely, the pain proved to be nociceptive and Pierre Marie-Bamberger syndrome was the positive diagnosis in our patient, as it can be associated with numerous diseases, especially of neoplastic origin.

Secondary hypertrophic osteoarthropathy associated with solitary fibrous tumor of the lung

Secondary hypertrophic osteoarthropathy, synonymous with the terms "pulmonary hypertrophic osteoarthropathy" and "pachydermoperiostosis acquisita," is a syndrome characterized by finger clubbing, hypertrophic skin changes, and periosteal bone changes that can occur in patients with underlying disease of the cardiovascular and pulmonary systems. We report the case of a 56-year-old man with a solitary fibrous tumor of the lung causing symptomatic hypoglycemia and secondary hypertrophic osteoarthropathy. The patient was seen in the dermatology clinic because of his skin changes. Diagnostic work-up included imaging that revealed a large mass in the left lower lobe of his lung later identified as a solitary fibrous tumor. The patient underwent pneumonectomy and at 1-month follow-up had returned to a euglycemic state with resolution of his skin findings. Dermatologists may play a key role in early diagnosis of tumors of the lung and other extrathoracic sites, such as solitary fibrous tumors, as well as many endocrine disorders, through the recognition of the cutaneous and soft tissue manifestations.