Thompson J T, Paschold E H, Levine E A
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.
Am Surg. 2001 Jun;67(6):585-8.
Hypercalcemia is a well-known manifestation of paraneoplastic syndromes associated with a variety of malignancies. However, colon cancer has only rarely been associated with hypercalcemia of malignancy. We present the case of a patient with recurrent adenosquamous carcinoma of the ascending colon found to have hypercalcemia. The patient is a 76-year-old white woman who initially presented with colon cancer in the cecum and underwent a right hemicolectomy. All lymph nodes and surgical margins were free of tumor. Pathological examination at that time revealed adenosquamous carcinoma of the colon. Eight months later she complained of dizziness, anorexia, and constipation and was found to have a calcium level of 13.6 mg/dL. CT scan revealed a mass measuring 10.5 to 12.7 cm in the right hepatic lobe, and a bone scan was normal. Her intact parathyroid hormone (PTH) level was 6 pg/mL (normal 12-72) and her PTH-related protein (PTHrP) level was 25.7 pmol/L (normal <1.3). She then underwent a hepatic resection. The serum PTH, calcium, and PTHrP levels normalized after resection. Hypercalcemia of malignancy in colon cancer is rare and has an association with adenosquamous histology. The hypercalcemia is attributed to PTHrP, and here we demonstrate this in the serum and tumor specimens. The effects of PTHrP are shown to be short-lived postoperatively. We find only 14 other cases in the literature of hypercalcemia related to a colonic neoplasm, and this is the only patient reported to be surviving. The diagnosis of a paraneoplastic syndrome mediated via PTHrP should be considered when hypercalcemia is encountered in the setting of metastatic colon carcinoma.
高钙血症是与多种恶性肿瘤相关的副肿瘤综合征的一种众所周知的表现。然而，结肠癌很少与恶性肿瘤性高钙血症相关。我们报告一例升结肠复发性腺鳞癌患者伴有高钙血症。该患者是一名76岁的白人女性，最初表现为盲肠结肠癌并接受了右半结肠切除术。所有淋巴结和手术切缘均无肿瘤。当时的病理检查显示为结肠腺鳞癌。八个月后，她出现头晕、厌食和便秘，血钙水平为13.6mg/dL。CT扫描显示右肝叶有一个大小为10.5至12.7cm的肿块，骨扫描正常。她的完整甲状旁腺激素（PTH）水平为6pg/mL（正常范围12 - 72），甲状旁腺激素相关蛋白（PTHrP）水平为25.7pmol/L（正常<1.3）。随后她接受了肝切除术。切除术后血清PTH、钙和PTHrP水平恢复正常。结肠癌中的恶性肿瘤性高钙血症罕见，且与腺鳞组织学有关。高钙血症归因于PTHrP，我们在此在血清和肿瘤标本中证实了这一点。PTHrP的作用在术后显示为短暂性。我们在文献中仅发现另外14例与结肠肿瘤相关的高钙血症病例，而该患者是唯一报告存活的。当在转移性结肠癌患者中遇到高钙血症时，应考虑由PTHrP介导的副肿瘤综合征的诊断。
