Department of Internal Medicine E, HaEmek Medical Center.
Endocrinology Unit, HaEmek Medical Center.
Medicine (Baltimore). 2021 Apr 9;100(14):e24982. doi: 10.1097/MD.0000000000024982.
Hypercalcemia is a common finding in patients with advanced-stage cancers. Paraneoplastic hypercalcemia is commonly associated with dismal prognoses, with survival rates of about 3 months. In this paper, we report on a patient with advanced chronic lymphocytic leukemia and non-small cell lung carcinoma who developed severe hypercalcemia and discuss the diagnosis and treatment of this metabolic complication.
A 56-year old male with a 2-year history of Rai stage IV chronic lymphocytic leukemia presented with life-threatening hypercalcemia. Positron emission tomography/computed tomography revealed a suspicious lung lesion. A transbronchial biopsy was performed from the upper left lobe. Due to the small size of the specimen, immunohistochemical markers were performed and revealed positive staining for cytokeratin 7 and negative for TTF-1, napsin A and p 40, which were consistent with non-small cell lung carcinoma.
Humoral hypercalcemia of malignancy was diagnosed.
The patient was treated with saline infusion, calcitonin, intravenous pamidronate, followed with denosumab.
The hypercalcemia was successfully treated and the patient's calcium levels returned to normal. Further evaluation revealed a non-small cell lung carcinoma as a second primary malignancy. The patient was treated with venetoclax for his refractory CLL and received chemotherapy and immunotherapy for lung adenocarcinoma. Several days after starting venetoclax, he developed Legionella pneumonia and short time after the second course of chemotherapy, a severe sepsis occurred and he passed away.
Coexistence of 2 unrelated malignancies, whichever could be a reason for hypercalcemia of malignancy is a rare event. Severe hypercalcemia, which is possible but rare feature of CLL should be a reason for further prompt evaluation.
高钙血症是晚期癌症患者的常见表现。副肿瘤性高钙血症通常与预后不良相关，生存率约为 3 个月。本文报告了一例晚期慢性淋巴细胞白血病和非小细胞肺癌患者发生严重高钙血症的病例，并讨论了这种代谢并发症的诊断和治疗。
一名 56 岁男性，患有 2 年 Rai 分期 IV 期慢性淋巴细胞白血病，出现危及生命的高钙血症。正电子发射断层扫描/计算机断层扫描显示左上叶可疑肺部病变。进行了经支气管活检。由于标本较小，进行了免疫组织化学标志物检测，显示细胞角蛋白 7 阳性，TTF-1、napsin A 和 p40 阴性，与非小细胞肺癌一致。
诊断为恶性肿瘤所致高钙血症。
患者接受生理盐水输注、降钙素、帕米膦酸二钠静脉滴注，随后使用地舒单抗。
高钙血症得到成功治疗，患者血钙水平恢复正常。进一步评估发现非小细胞肺癌为第二原发恶性肿瘤。患者因难治性 CLL 接受 venetoclax 治疗，并接受化疗和免疫治疗肺腺癌。开始 venetoclax 几天后，他发生军团菌肺炎，第二次化疗后不久，发生严重脓毒症，最终死亡。
两种不相关的恶性肿瘤共存，无论哪种是恶性肿瘤高钙血症的原因，都是罕见事件。CLL 可能出现但罕见的严重高钙血症应是进一步及时评估的原因。
