Botea Violeta, Edelson Gary W, Munasinghe Rajika L
Sinai-Grace Hospital, Detroit Medical Center, Wayne State University, Detroit, Michigan 48235, USA.
Endocr Pract. 2003 Jan-Feb;9(1):40-4. doi: 10.4158/EP.9.1.40.
To describe a patient with metastatic small cell lung carcinoma, who presented with hypercalcemia, a high level of intact parathyroid hormone (iPTH), and multiple calcified metastatic lesions in the brain.
We review the clinical findings, laboratory data, and results of imaging studies in our patient. In addition, we summarize the previously reported cases of ectopic iPTH-producing tumors.
A previously healthy 50-year-old man had a 2-month history of back pain, hip pain, and weight loss. Physical examination revealed a confused patient with dehydration, cachexia, and tenderness of the neck and both hips. His serum calcium concentration was 19.1 mg/dL, and the serum iPTH level was 107 pg/mL (normal range, 10 to 65). Imaging studies revealed multiple bilateral calcified metastatic lesions in the brain, a cavitary mass in the right lung, and osteolytic lesions in the left femur, pelvis, and spine. Biopsy of the femoral lesion yielded histologic findings consistent with small cell carcinoma. An immunohistochemistry stain was strongly positive for iPTH in the biopsy tissue.
Previously, only seven cases of true ectopic production of iPTH from nonparathyroid malignant lesions had been reported, of which only two were in patients with small cell carcinoma. We report the eighth such case and describe an association between hypercalcemia and calcified metastatic lesions, which has not been previously reported.
描述一名转移性小细胞肺癌患者，该患者出现高钙血症、高水平的完整甲状旁腺激素（iPTH）以及脑内多发钙化转移灶。
我们回顾了该患者的临床检查结果、实验室数据及影像学研究结果。此外，我们总结了先前报道的异位产生iPTH的肿瘤病例。
一名既往健康的50岁男性有2个月的背痛、髋部疼痛及体重减轻病史。体格检查发现患者意识模糊，伴有脱水、恶病质以及颈部和双侧髋部压痛。其血清钙浓度为19.1mg/dL，血清iPTH水平为107pg/mL（正常范围为10至65）。影像学研究显示脑内有多个双侧钙化转移灶、右肺有一个空洞性肿块以及左股骨、骨盆和脊柱有溶骨性病变。股骨病变活检的组织学结果符合小细胞癌。活检组织的免疫组化染色显示iPTH呈强阳性。
此前，仅有7例非甲状旁腺恶性病变真正异位产生iPTH的病例报道，其中仅有2例为小细胞癌患者。我们报告第8例此类病例，并描述了高钙血症与钙化转移灶之间的关联，这在此前尚未见报道。
