Futagami Masayuki, Yokoyama Yoshihito, Wakui Moe, Taniguchi Ryousuke, Higuchi Tsuyoshi, Mizunuma Hideki
Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, 5-Zaifu-cho, Hirosaki, Aomori 036-8562, Japan.
World J Oncol. 2010 Jun;1(3):138-141. doi: 10.4021/wjon2010.06.214w. Epub 2010 May 19.
We describe the first report of an ovarian clear cell carcinoma simultaneously producing parathyroid hormone-related protein (PTHrP) and granulocyte colony-stimulating factor (G-CSF). A 64-year-old woman complained of general fatigue, loss of appetite, nausea, vomiting and constipation. The results of blood and biochemistry tests were white blood cell count of 21,060 /ml and calcium of 18.0 mg/dl, indicating an increase in the number of leukocytes and hypercalcemia. A computerized tomography scan showed a tumor in the lower abdomen with a maximum diameter of 16 cm and containing both cystic and solid parts. There was a remarkable elevation of the tumor marker CA 19-9, to 1611 IU/ml, and serum level of PTHrP was elevated to 25.9 pmol/ml. The PTH-intact level was 14 pg/ml, which was at the lower limit of the normal range. In addition, the G-CSF level was also elevated to 73 pg/ml (normal range: <38 pg/ml). Since hypercalcemia caused by tumor PTHrP production was suspected, and as this required elimination of the primary disease, extirpation of the tumor was carried out. Serum calcium levels promptly returned to 11.1 mg/ml on the first day following surgery, and PTHrP also dropped to its normal level on the same day. Histological and immunohistochemical examinations revealed that the tumor was clear cell adenocarcinoma which was partially positive for PTHrP and positive for G-CSF, indicating the tumor simultaneously producing PTHrP and G-CSF.
我们报告首例同时产生甲状旁腺激素相关蛋白（PTHrP）和粒细胞集落刺激因子（G-CSF）的卵巢透明细胞癌。一名64岁女性主诉全身乏力、食欲不振、恶心、呕吐及便秘。血液和生化检查结果显示白细胞计数为21,060 /ml，血钙为18.0 mg/dl，提示白细胞增多和高钙血症。计算机断层扫描显示下腹部有一肿瘤，最大直径为16 cm，包含囊性和实性部分。肿瘤标志物CA 19-9显著升高至1611 IU/ml，血清PTHrP水平升高至25.9 pmol/ml。完整PTH水平为14 pg/ml，处于正常范围下限。此外，G-CSF水平也升高至73 pg/ml（正常范围：<38 pg/ml）。由于怀疑肿瘤产生PTHrP导致高钙血症，且这需要消除原发疾病，遂进行了肿瘤切除。术后第一天血清钙水平迅速恢复至11.1 mg/ml，PTHrP在同一天也降至正常水平。组织学和免疫组化检查显示该肿瘤为透明细胞腺癌，PTHrP部分阳性，G-CSF阳性，表明肿瘤同时产生PTHrP和G-CSF。
