Hypertrophic Osteoarthropathy Secondary to Upper-gastrointestinal-tract Neoplasm

Abstract

Recovery of a 54-year-old white woman with severe and characteristic hypertrophic osteoarthropathy occurred following the removal of a benign neoplasm of the esophagus, a myxoma. At death due to pulmonary embolism, no evidence of intrathoracic extension was found. Myxomatous tissue was present at the site of excision. Only 5 other cases of upper gastrointestinal neoplasia associated with hypertrophic osteoarthropathy have been described. All other autopsied cases showed either pulmonary or hilar metastases. All were due to malignant lesions: 1 carcinoma of the esophagus, 1 carcinoma of the stomach, and 2 carcinoma of the nasopharynx. The absence of pulmonary involvement indicates that hypertrophic osteoarthropathy is not necessarily associated with pulmonary disease. The neural reflex mechanisms postulated seem unlikely in view of the narrow stalk of the reported myxoma and the lack of neural connections. Autonomic pulmonary-systemic vascular reflex as a mechanism also is improbable. The only tenable postulate is that of a hormonal substance produced by the tumor.