Kobayashi Noritoshi, Higurashi Takuma, Iida Hiroshi, Mawatari Hironori, Endo Hiroki, Nozaki Yuichi, Tomimoto Ayako, Yoneda Kyoko, Akiyama Tomoyuki, Fujita Koji, Takahashi Hirokazu, Yoneda Masato, Inamori Masahiko, Abe Yasunobu, Kirikoshi Hiroyuki, Kubota Kensuke, Saito Satoru, Ueno Norio, Nakajima Atsushi, Yamanaka Shoji, Inayama Yoshiaki
Department of Gastroenterology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
J Hepatobiliary Pancreat Surg. 2008;15(5):531-5. doi: 10.1007/s00534-007-1258-x. Epub 2008 Oct 4.
We report a rare case of adenosquamous carcinoma of the pancreas associated with humoral hypercalcemia of malignancy (HHM) in which parathyroid hormone-related protein (PTH-rP) was identified as the causative factor of hypercalcemia. A 72-year-old Japanese man was admitted to our institution complaining of fever and abdominal pain. Abdominal computed tomography demonstrated a large tumor in the body of the pancreas, with multiple liver metastases. Both serum calcium and PTH-rP levels were elevated. No accumulation was observed on bone scan with technetium-99. The patient died of pneumonia 3 months after admission. Autopsy demonstrated that the neoplasm in the pancreas showed an abrupt histological transition from adenocarcinoma to squamous cell carcinoma. PTH-rP was identified in the primary pancreatic tumor cells by immunohistochemical examination and a reverse-transcription polymerase chain reaction (RTPCR) method. We concluded that PTH-rP was the causative factor of the HHM, based on the laboratory data, immunohistochemical examination, and messenger RNA (mRNA) expression. This is a very rare report of adenosquamous cell carcinoma of the pancreas associated with HHM.
我们报告了一例罕见的胰腺腺鳞癌合并恶性肿瘤体液性高钙血症（HHM）病例，其中甲状旁腺激素相关蛋白（PTH-rP）被确定为高钙血症的病因。一名72岁的日本男性因发热和腹痛入院。腹部计算机断层扫描显示胰体部有一个大肿瘤，并伴有多发肝转移。血清钙和PTH-rP水平均升高。锝-99骨扫描未发现骨转移灶。患者入院3个月后死于肺炎。尸检显示胰腺肿瘤在组织学上表现为从腺癌到鳞状细胞癌的突然转变。通过免疫组织化学检查和逆转录聚合酶链反应（RTPCR）方法在原发性胰腺肿瘤细胞中检测到PTH-rP。基于实验室数据、免疫组织化学检查和信使核糖核酸（mRNA）表达，我们得出结论，PTH-rP是HHM的病因。这是关于胰腺腺鳞癌合并HHM的非常罕见的报告。
