[Clubbed fingers in a case of low-malignancy leiomyosarcoma and mixed-type hiatal hernia]

The husband of a 33-year-old woman had noticed clubbing of her finger nails. She herself reported frequent gastric reflux symptoms. Admission findings were unremarkable except for finger clubbing.

Erythrocyte sedimentation rate (ESR) was raised to 23/68 and she had a hypochromic iron-deficiency anaemia (haemoglobin 11.1 g/dl, RBC count 4.24 x 10(6)/microliters, iron concentration 31 micrograms/dl, ferritin 15.2 micrograms/dl) and an increase in platelets (431 x 10(3)/microliters). Chest radiogram showed a retrocardiac dense and round shadow, 10 cm in diameter, which on abdominal sonography was an echo-poor structure that could be traced far cranial. Gastroscopy and double-contrast radiology of the stomach revealed a 14 cm long hiatal hernia of mixed type and a submucous tumour in the anterior wall, which on computed tomography was a 6 cm subcardiac tumour, the stomach lying largely within the chest.

At surgery the stomach was intrathoracic except for a short antral portion. Because of the size of the tumour, 15.10 cm, a gastrectomy was performed. Histologically it was a leiomyosarcoma of low malignancy. Postoperatively the ESR fell to 12/28 mm and the anaemia regressed (haemoglobin 13.5 g/dl, RBC 4.95 x 10(6)/microliters). Two years later there was no sign of local tumour recurrence and the finger clubbing had largely disappeared.

Recently developed finger clubbing should always be an indication for further investigation. In addition to the wellknown cardiopulmonary diseases, one of a number of other treatable causes may be responsible. Research of literature revealed no comparable case.