Hoshi Senji, Numahata Kenji, Morozumi Kento, Katumata Yuuki, Kuromoto Akito, Takai Yuuki, Hoshi Kiyotugu, Bilim Vladimir, Sasagawa Isoji
Department of Urology Yamagata Tokushukai Hospital Yamagata Japan.
Department of Urology Yamagata Prefectural Central Hospital Yamagata Japan.
IJU Case Rep. 2018 Dec 14;2(1):47-50. doi: 10.1002/iju5.12036. eCollection 2019 Jan.
In urothelial cancer, several paraneoplastic syndromes can be triggered by the aberrant expression of hormones, growth factors or lymphokines by tumor cells.
A 71-year-old female patient underwent radical cystectomy for muscle-invasive urothelial cancer. Shortly after the operation, the patient presented with a leukemoid reaction and hypercalcemia. Computed tomography scans revealed a rapidly progressing tumor on the left pelvic side, and serum levels of granulocyte-colony stimulating factor, parathyroid hormone-related protein, and beta human chorionic gonadotropin were elevated. The patient also tested positive for serum squamous cell carcinoma antigen. Hypercalcemia was successfully treated with denosumab. However, the patient's leukocyte counts steadily increased, her condition deteriorated and she passed away.
To the best of our knowledge, this is the first report of urothelial cancer that tested positive for four tumor markers. The findings support the idea that poorly differentiated bladder carcinomas can ectopically secrete multiple proteins causing pleiotropic paraneoplastic syndromes.
在尿路上皮癌中，肿瘤细胞异常表达激素、生长因子或淋巴因子可引发多种副肿瘤综合征。
一名71岁女性患者因肌层浸润性尿路上皮癌接受了根治性膀胱切除术。术后不久，患者出现类白血病反应和高钙血症。计算机断层扫描显示左盆腔侧有一个进展迅速的肿瘤，血清粒细胞集落刺激因子、甲状旁腺激素相关蛋白和β人绒毛膜促性腺激素水平升高。患者血清鳞状细胞癌抗原检测也呈阳性。地诺单抗成功治疗了高钙血症。然而，患者白细胞计数持续增加，病情恶化，最终死亡。
据我们所知，这是首例四种肿瘤标志物检测均呈阳性的尿路上皮癌报告。这些发现支持了低分化膀胱癌可异位分泌多种蛋白质导致多效性副肿瘤综合征的观点。
