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Rheumatology Advance Access originally published online on June 28, 2008
Rheumatology 2008 47(9):1277; doi:10.1093/rheumatology/ken235
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Hypertrophic osteoarthropathy associated with a left ventricular tumour

R. Suppiah1 and F. McQueen2

1Department of Rheumatology, Auckland District Health Board, Greenlane Clinical Centre and 2Department of Molecular Medicine and Pathology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand

Correspondence to: R. Suppiah, Rheumatology Registrar, Department of Rheumatology, Auckland District Health Board, Greenlane Clinical Centre, Private Bag 92189, Auckland Mail Centre, Auckland 1142, New Zealand. E-mail: RSuppiah{at}adhb.govt.nz

The patient, a 36-yr-old Polynesian man, presented with a 3-month history of swelling of his extremities with clubbing of the fingers and toes and polyarthritis affecting his hands, feet and knees. Plain radiographs revealed extensive periosteal reaction along the shafts of the metacarpals (arrow in A). Axial proton density fat saturated sequence on MRI shows periosteal new bone (short arrow in B) involving the shafts of the metacarpals giving a ‘halo’ appearance. There is also associated periosteal oedema showing high signal (long arrow). The patient was eventually diagnosed with a high-grade undifferentiated pleomorphic sarcoma of his left ventricle (C, D). The hematoxylin and eosin (H&E) section taken from the resected tumour (C) shows pleomorphic spindle cell proliferation, bizarre nuclei and atypical mitoses.

Vascular endothelial growth factor (VEGF), a cytokine normally inactivated in the lungs, has been implicated in the pathogenesis of hypertrophic osteoarthropathy [1].

Disclosure statement: The authors have declared no conflicts of interest.

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References

  1. Olan F, Portela M, Navarro C, et al. Circulating vascular endothelial growth factor concentrations in a case of pulmonary hypertrophic osteoarthropathy. Correlation with disease activity. J Rheumatol (2004) 31:614–6.[Web of Science][Medline]
Accepted 28 May 2008


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This Article
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