ABSTRACT
Approximately 5% of gynecological malignancies are associated with paraneoplastic hypercalcemia. Awareness of its association with certain tumor types allows for earlier disease detection and facilitates monitoring of treatment response and disease recurrence. We review the salient clinicopathological features, differential diagnosis and management issues in some of these gynecological tumors, namely: small cell carcinoma, hypercalcemic type; ovarian clear cell carcinoma, dysgerminoma and juvenile granulosa cell tumors.
Subject(s)
Genital Neoplasms, Female/complications , Hypercalcemia/etiology , Paraneoplastic Syndromes/etiology , Female , HumansABSTRACT
Multiple primary malignancies (MPMs) are defined as having more than one primary malignancy and when each tumor is histologically distinct and unrelated to the others. Multiple risk factors have been found to be associated with MPMs. These include familial syndromes, sequela from treatments of previous malignancies, and environmental factors such as smoking, alcohol consumption, obesity, and male sex. Hypercalcemia has a well-known association with malignancy and is often the first abnormality that leads to further testing. Lung cancer followed by colorectal cancer has the highest mortality of all cancers in the USA, with adenocarcinoma being the most prevalent histological subtype. Further, estimates show that those with one malignancy have a 1.29 times higher risk of developing another malignancy. Hereby, we present a case of a patient with squamous cell carcinoma of the lung who presented with hypercalcemia and incidentally was found to have another primary adenocarcinoma of the colon.
ABSTRACT
Background: Hypercalcemia is a common paraneoplastic syndrome which can occur in up to 10% of patients with advanced neoplasms. Paraneoplastic parathyroid hormone-related protein (PTHrP) represents the most frequent cause of this syndrome. In neuroendocrine neoplasms (NENs) paraneoplastic hypercalcemia is rare. Case Series: The present series includes all patients with NENs and paraneoplastic hypercalcemia from four Italian centres: (I) A 40-year-old man was hospitalized for repeated episodes of falls, hyposthenia and drowsiness. Severe hypercalcemia was found. Metastatic pancreatic G2 NEN and PTHrP-related hypercalcemia were diagnosed. The patient started therapy with somatostatin analogs (SSA) and Denosumab. After disease progression peptide receptor radionuclide therapy (PRRT) was started with an objective response associated with PTHrP reduction and normocalcemia. (II) A 45-year-old man was referred for pancreatic G2 NEN. SSA and subsequently everolimus were administered for metastases occurrence. Hypercalcemia occurred and PRRT and Denosumab were started for disease progression with the onset of bone metastases. Despite disease stability after four cycles of PRRT the patient's performance status worsened until death. (III) A 49-year-old woman was hospitalized for psychic slowdown, confusional state, sensory dullness. A severe hypercalcemia, associated with a pancreatic G1 NEN was diagnosed and treated with haemodialysis, bisphosphonates injections and continuous infusion of calcitonin. 1,25-dihydroxyvitamin D was high, PTHrP was undetectable. After surgery serum calcium levels and 1,25-dihydroxyvitamin D were normalized. (IV) A 69-year-old man was hospitalized after the onset of shortness of breath and dyspnea, asthenia and weight loss. Computed Tomography (CT) and 68Ga DOTATOC Positron Emission Tomography (PET)-CT revealed a left pulmonary nodule. Hypercalcemia and markedly elevated PTHrP levels were detected. The histological examination revealed an atypical carcinoid. After surgery, calcium levels were normalized, PTHrP was significantly reduced with an improvement of general conditions. Conclusion: In our series, paraneoplastic PTHrP-related hypercalcemia occurred in pancreatic NEN and in one bronchial carcinoid representing the third case in the literature. Our case associated with 1,25-dihydroxyvitamin D secretion represents the fourth case in the literature. PTHrP secretion should be considered in NENs' patients with hypercalcemia. Acute treatment should be focused on lowering calcium levels, and long-term control can be achieved by tumor cytoreduction inhibiting PTHrP release.
Subject(s)
Hypercalcemia/diagnosis , Neuroendocrine Tumors/complications , Pancreatic Neoplasms/complications , Adult , Aged , Female , Humans , Hypercalcemia/etiology , Hypercalcemia/metabolism , Male , Middle Aged , Prognosis , Vitamin D/analogs & derivatives , Vitamin D/metabolismABSTRACT
A 73-year-old woman with a diagnosis of vulvar carcinoma submitted to curative surgery 5 years previously, presented to the emergency department with prostration and vulvar haemorrhage. Although the gynaecological examination was unremarkable, she had a mass in the left chest wall and hypercalcemia. A CT scan of the thorax revealed a voluminous left hemithorax mass invading the mediastinum, lung, pleura and chest wall. Ultrasound-guided biopsy of the mass showed infiltration by a well-differentiated keratinizing squamous cell carcinoma (SCC). This case report describes an extremely rare metastatic pattern in vulvar SCC concomitant with paraneoplastic hypercalcemia. LEARNING POINTS: Pulmonary metastasis of vulvar carcinoma with chest wall invasion should be included in the list of rare manifestations of squamous cell carcinoma.Hypercalcaemia is common in squamous cell carcinoma but rare in vulvar carcinoma, and is associated with a bad prognosis.
ABSTRACT
The immunodeficiency virus infection is known to increase the risk of malignancies, including lymphomas. We report a case of a 51-year-old male with a history of human immunodeficiency virus (HIV) infection, well-controlled on antiretroviral treatment, who presented with polyarthritis and hypercalcemia due to an elevated parathyroid-hormone-related peptide. Computer tomography (CT) revealed diffuse lymphadenopathy and a lymph node biopsy revealed large B-cell lymphoma. He was treated and responded well to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy regimen. Our case highlights the importance of recognizing inflammatory arthritis as an initial manifestation of occult malignancy like large B-cell lymphoma, as the arthritis preceded his eventual diagnosis of lymphoma by several months.
ABSTRACT
Low-risk human papillomavirus types 6 and 11 can manifest as giant condylomata acuminata (GCA) of Buschke-Lowenstein. Up to 50% of GCA can slowly progress over years to fungating, invasive tumors. The malignant potential is attributed to unique immune evading abilities of the human papillomavirus. A 42-year-old male presented with pain and foul-smelling discharge from his genital warts. The histopathological examination of the mass showed invasive squamous cell carcinoma, and it was associated with paraneoplastic hypercalcemia. The timely removal of long-standing GCA in order to prevent a carcinomatous transition is a priority.
ABSTRACT
Parathyroid hormone mediated hypercalcemia is not always exclusively primary hyperparathyroidism and rarely could be due to ectopic parathyroid hormone secretion from tumor cells. We present a case of 86-year-old female with metastatic gall bladder adenocarcinoma diagnosed eight months back who presented with generalized fatigue and poor oral intake and was found to be hypercalcemic with elevated parathyroid hormone levels. Imaging with technetium 99 m sestamibi scintigraphy with dual phase, subtraction thyroid scan (dual isotope scintigraphy), magnetic resonance imaging and ultrasonography did not demonstrate any parathyroid lesion in normal or ectopic sites. We believe that the tumor cells were the source of ectopic parathyroid hormone secretion as we had excluded all the other possibilities with extensive combined imaging thereby increasing the sensitivity of our testing. We report the first case of metastatic gall bladder adenocarcinoma with paraneoplastic ectopic parathyroid hormone secretion.
ABSTRACT
In this report, we describe the case of a 46-year-old male who presented with a three-month history of progressive intermittent pain over the right posterior knee. Magnetic resonance imaging showed soft tissue masses over the right popliteal fossa. Surgery was performed, and histological examination revealed the mass to be a sarcomatoid carcinoma of poor differentiation. Fluorodeoxyglucose (FDG)-positron emission tomography showed FDG uptake in the lungs and in the right para-aortic and popliteal regions. On the basis of the morphological and immunohistochemical features of the specimens, the patient's condition was diagnosed as a pulmonary pleomorphic carcinoma with multiple metastases. Systemic chemotherapy was initiated with paclitaxel and cisplatin. The patient then developed paraneoplastic hypercalcemia and ultimately succumbed to healthcare-acquired pneumonia. The results of this rare case indicate that pulmonary pleomorphic carcinomas respond poorly to combination chemotherapy with paclitaxel and cisplatin. The firm mass in the popliteal fossa that was situated behind the knee was considered to be a Baker cyst; however, the possibility of malignant metastatic sarcomas, such as pulmonary sarcomatoid carcinoma, should be considered in the differential diagnosis. In conclusion, we emphasize that pretherapeutic examinations should be the basis for the diagnosis of a mass lesion at either an unusual or usual site.