Motilal Nehru Vijeyaluxmy, Garcia Gwenalyn, Ding Juan, Kong Fanyi, Dai Qun
Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.
Department of Medicine, Division of Hematology/Oncology, Staten Island University Hospital, Staten Island, NY, USA.
Am J Case Rep. 2017 Jan 6;18:22-25. doi: 10.12659/ajcr.900088.
BACKGROUND Paraneoplastic hypercalcemia is a well-described complication associated with a variety of malignancies. However, its incidence in gynecological malignancies is low. CASE REPORT A 53-year-old woman presented with progressive abdominal distention and irregular vaginal bleeding of several weeks' duration. A contrast CT abdomen and pelvis was significant for a mass in the lower uterine/cervical region, multiple peritoneal and omental masses, enlarged pelvic and paraaortic lymph nodes, and large-volume ascites. A pelvic exam revealed a fungating vaginal mass, with biopsy showing a high-grade tumor with immunohistochemical staining positive for vimentin, CD10, and cyclin D1, consistent with endometrial stromal sarcoma. During her hospitalization, the patient became increasingly lethargic. Workup showed severe hypercalcemia and evidence of acute kidney injury. The patient did not have evidence of bony metastatic disease on imaging studies. Further laboratory evaluation revealed an elevated PTHrP of 301 pg/mL (nl 14-27), a depressed PTH level of 3 pg/mL (nl 15-65), and a depressed 25-OH vitamin D level of 16 ng/mL (nl 30-100), consistent with humoral hypercalcemia of malignancy. The patient was treated with pamidronate, calcitonin, and intravenous fluids. She eventually required temporary hemodialysis and denosumab for refractory hypercalcemia, which improved her electrolyte abnormalities and clinical status. CONCLUSIONS Uterine malignancies of various histologies are increasingly recognized as a cause of humoral hypercalcemia. They are an important differential diagnosis in a woman with hypercalcemia and abnormal vaginal bleeding or abdominal symptoms.
背景 副肿瘤性高钙血症是一种与多种恶性肿瘤相关的已被充分描述的并发症。然而，其在妇科恶性肿瘤中的发生率较低。病例报告 一名53岁女性出现进行性腹胀和持续数周的不规则阴道出血。腹部和盆腔增强CT显示子宫下段/宫颈区域有肿块、多个腹膜和网膜肿块、盆腔及腹主动脉旁淋巴结肿大以及大量腹水。盆腔检查发现阴道有赘生物性肿块，活检显示为高级别肿瘤，免疫组化染色波形蛋白、CD10和细胞周期蛋白D1呈阳性，符合子宫内膜间质肉瘤。在住院期间，患者变得越来越嗜睡。检查显示严重高钙血症及急性肾损伤的证据。影像学检查未发现骨转移疾病的证据。进一步的实验室评估显示甲状旁腺激素相关蛋白（PTHrP）升高至301 pg/mL（正常范围14 - 27），甲状旁腺激素（PTH）水平降低至3 pg/mL（正常范围15 - 65），25 - 羟基维生素D水平降低至16 ng/mL（正常范围30 - 100），符合恶性肿瘤性体液性高钙血症。患者接受了帕米膦酸盐、降钙素和静脉补液治疗。她最终因难治性高钙血症需要临时血液透析和地诺单抗治疗，这改善了她的电解质异常和临床状况。结论 各种组织学类型的子宫恶性肿瘤越来越被认为是体液性高钙血症的一个原因。它们是高钙血症且伴有异常阴道出血或腹部症状女性的重要鉴别诊断。
