Sharif Sadia, Shah Amir Ali
Department of Gastroenterology and Hepatology, Crosshouse Hospital, Kilmarnock, UK.
J Pak Med Assoc. 2013 Feb;63(2):263-4.
The incidence of hepatocellular carcinoma (HCC) is increasing. In addition, its presentation without bony metastasis as a part of paraneoplastic syndrome is recognised but uncommon. This unusual presentation of HCC is highlighted in the case of a 63 years old lady, who presented with lethargy and tiredness and hypercalcaemia due to secretion of parathryoid hormone related peptide (PTHrP). Further imaging showed 11 cm hepatic mass, with normal alpha fetoprotein. She underwent partial hepatectomy and is doing well since then. Malignant hypercalcaemia is thought to arise from the secretion of PTHrP which is synthesised by tumour cells and has a similar action to parathyroid hormone. Early recognition of this uncommon condition can lead to complete cure as seen in our patient.
肝细胞癌（HCC）的发病率正在上升。此外，它作为副肿瘤综合征的一部分而无骨转移的表现已得到认可，但并不常见。一名63岁女性患者的病例突出了HCC这种不寻常的表现，该患者因甲状旁腺激素相关肽（PTHrP）分泌而出现嗜睡、疲倦和高钙血症。进一步的影像学检查显示肝脏有一个11厘米的肿块，甲胎蛋白正常。她接受了部分肝切除术，从那以后情况良好。恶性高钙血症被认为是由肿瘤细胞合成的PTHrP分泌引起的，PTHrP与甲状旁腺激素具有相似的作用。如我们的患者所示，早期识别这种罕见情况可实现完全治愈。
