Akai P S, Wong T, Chang-Poon V, Green F, Whitelaw W A, Hanley D A
Department of Medicine, Foothills Hospital, Calgary, Alberta.
Clin Invest Med. 1989 Jun;12(3):212-6.
A patient with hypercalcemia, increased levels of 1,25-dihydroxyvitamin D, and a resectable squamous cell bronchogenic carcinoma surrounded by numerous non-caseating epithelioid granulomas, achieved normocalcemia, decreased levels of 1,25-dihydroxyvitamin D, and no evidence of tumor recurrence at 30 months following complete resection of his tumor. We suggest that an excess production of 1,25-dihydroxyvitamin D, through the granulomatous reaction around the tumor, was the mechanism of hypercalcemia. To our knowledge, no such mechanism of hypercalcemia has been previously reported with bronchogenic carcinoma. Furthermore, a review of the literature reveals that in cases of bronchogenic carcinoma, hypercalcemia is almost always associated with large and unresectable tumors, with a median survival after the discovery of hypercalcemia of only one month. This case, then, is unique because it describes an unusual mechanism of hypercalcemia with bronchogenic carcinoma and it emphasizes the rare occurrence of the potentially curable patient presenting with bronchogenic carcinoma complicated by hypercalcemia.
一名患有高钙血症、1,25-二羟维生素D水平升高且患有可切除的鳞状细胞支气管癌的患者，其肿瘤周围有许多非干酪样上皮样肉芽肿。在肿瘤完全切除后的30个月时，患者血钙恢复正常，1,25-二羟维生素D水平降低，且无肿瘤复发迹象。我们认为，肿瘤周围的肉芽肿反应导致1,25-二羟维生素D过度产生是高钙血症的机制。据我们所知，此前尚未有支气管癌导致高钙血症的此类机制的报道。此外，文献回顾显示，在支气管癌病例中，高钙血症几乎总是与大的、不可切除的肿瘤相关，发现高钙血症后的中位生存期仅为1个月。因此，该病例很独特，因为它描述了支气管癌导致高钙血症的一种不寻常机制，并且强调了患有支气管癌并伴有高钙血症的潜在可治愈患者的罕见情况。
