Digital Clubbing and Hypertrophic Osteoarthropathy -an Early Indicator of Pulmonary Metastasis of Nasopharyngeal Carcinoma - Report of a Case

杵狀指與肥厚性骨關節病變-－鼻咽癌併發肺轉移的早期指標 －病例報告

10.6440/TZUCMJ.199909.0291

沈挺毅(Ting-Yi Shen)；沈宗憲(Tzung-Shiahn Sheen)；徐茂銘(Mow-Ming Hsu)

杵狀指 ； 肥厚性骨關節病變 ； 鼻咽癌 ； digital clubbing ； hypertrophic osteoarthropathy ； nasopharyngeal carcinoma

慈濟醫學雜誌

11卷3期（1999 / 09 / 01）

291 - 295

英文

在許多肺部、心血管與腸胃系統疾病都會併發杵狀指與肥厚性骨關節病變。肥厚性骨關節病變的大部分病例都與肺部腫瘤有關，而且被認為是肺部腫瘤發生的早期指標。然而在台灣常見的頭頸部腫瘤—鼻咽癌，杵狀指與肥厚性骨關節病變卻相當罕見。文獻中的報告病例都是以骨頭酸痛、關節炎症狀為初始主訴。本文報告一27歲男性鼻咽癌患者，杵狀指是其併發肺部轉移的唯一表現。全身骨骼掃描與胸部電腦斷層證明肥厚性骨關節病變與肺部轉移的診斷。本文強調杵狀指與骨關節症狀在鼻咽癌的臨床重要性。

Digital clubbing and hypertrophic osteoarthropathy (HOA) are encountered in a variety of intrathoracic, cardiovascular, hepatic and gastronintestinal diseases. HOA is especially associated with imtrapulmonary neoplasms and is regarded as an early indicator of primary or metastastic lung cancer. However, HOA has rarely been reported in nasopharyngeal carcinoma (NPC), a common head and neck malignancy in Taiwan with frequent distant metastasis. Previously reported cases were all initially noted to have rheumatic symptoms of HOA such as bone pain and arthralgia. We describe a 27-year-old man with NPC and pulmonary metastasis. Digital clubbing was the only clinical manifestation of HOA, which was confirmed with a bone scan. Pulmonary metastasis was confirmed later with chest CT.