Hirabayashi Masahiro, Koizumi Tomonobu, Nakajima Daichi, Azegami Shuko, Midorikawa Hajime, Kitagawa Nami, Hamano Hideaki, Chino Tatsunori, Ohya Maki
Department of Medicine, Nagano Prefectureal Kiso Hospital, Kiso, Nagano, Japan.
Shinshu Cancer Center, Shinshu University Hospital, Nagano, Japan.
Case Rep Oncol. 2024 Aug 12;17(1):900-905. doi: 10.1159/000540418. eCollection 2024 Jan-Dec.
Lung adenocarcinoma with parathyroid hormone (PTH)-related hypercalcemia is uncommon.
A 69-year-old man was admitted to our hospital due to anorexia and fatigue. Serum calcium (15.0 mg/dL) and carcinoembryonic antigen (361.7 ng/mL) were extremely high, and PTH-related protein (PTH-rP) also elevated (16.7 pmol/L). Systemic computed tomography revealed multiple enlarged lymph nodes and disseminated peritoneal nodules, with irregularly shaped nodules in the upper lobe in the left lung. Ultrasound-guided biopsy from the axillary lymph node revealed adenocarcinoma. Immunohistological staining showed the tumor cells to be positive for cytokeratin 7 and PTH-rP and negative for cytokeratin 20 and thyroid transcription factor-1. Although the primary origin remains undetermined despite detailed examinations, possible primary tumor was considered to be lung adenocarcinoma in the present case. The serum calcium level was reduced by denosumab, but the patient died 20 days after admission.
The present case demonstrated the importance of considering oncological emergency, such as hypercalcemia and/or PTH-rP-producing hypercalcemia, in patients with adenocarcinoma.
伴有甲状旁腺激素（PTH）相关高钙血症的肺腺癌并不常见。
一名69岁男性因厌食和疲劳入院。血清钙（15.0mg/dL）和癌胚抗原（361.7ng/mL）极高，甲状旁腺激素相关蛋白（PTH-rP）也升高（16.7pmol/L）。全身计算机断层扫描显示多个肿大淋巴结和弥漫性腹膜结节，左肺上叶有不规则形结节。腋窝淋巴结超声引导下活检显示为腺癌。免疫组织化学染色显示肿瘤细胞细胞角蛋白7和PTH-rP呈阳性，细胞角蛋白20和甲状腺转录因子-1呈阴性。尽管经过详细检查仍未确定原发灶，但本病例中可能的原发肿瘤被认为是肺腺癌。地诺单抗使血清钙水平降低，但患者入院20天后死亡。
本病例表明在腺癌患者中考虑肿瘤急症如高钙血症和/或产生PTH-rP的高钙血症的重要性。
