Matsuoka S, Miura Y, Kachi T, Hattori Y, Ohno J, Oda K, Nagamura Y, Oiso Y
Department of Internal Medicine, Nakatsugawa Municipal General Hospital.
Intern Med. 1994 Feb;33(2):107-9. doi: 10.2169/internalmedicine.33.107.
A 78-year old male with ureteral carcinoma manifesting hypercalcemia is reported. He was diagnosed as having ureteral carcinoma of the left side 2 years previously and was treated by nephrectomy with ureterovesicostomy. In October 1991, he was admitted for anorexia. A clinical examination revealed recurrence of the ureteral carcinoma with metastasis to the rectum and liver. His serum calcium level was elevated (13.9 mg/dl). In addition to rehydration and furosemide, treatment with eel-calcitonin and prednisolone failed to decrease his serum calcium level. Finally, he was administered mithramycin but he died 13 days later. He had no evidence of bone metastasis or hyperparathyroidism. Nephrogenic cAMP and urinary parathyroid hormone-related protein (PTHrP) were markedly elevated. Immunohistochemical study demonstrated expression of PTHrP in the tumor cells. Thus, the hypercalcemia was thought to be mediated by PTHrP secreted from the neoplastic tumor. Although there have been several reports of ureteral carcinoma associated with humoral hypercalcemia of malignancy, this is considered to be the first case associated with elevation of PTHrP.
本文报道了一名78岁患输尿管癌并伴有高钙血症的男性患者。他于2年前被诊断为左侧输尿管癌，并接受了肾切除术及输尿管膀胱吻合术治疗。1991年10月，因食欲不振入院。临床检查发现输尿管癌复发并转移至直肠和肝脏。其血清钙水平升高（13.9mg/dl）。除补液和使用速尿外，给予鳗鱼降钙素和泼尼松龙治疗未能降低其血清钙水平。最后，给予光辉霉素治疗，但患者13天后死亡。患者无骨转移或甲状旁腺功能亢进的证据。肾源性环磷酸腺苷（cAMP）和尿甲状旁腺激素相关蛋白（PTHrP）显著升高。免疫组化研究显示肿瘤细胞中有PTHrP表达。因此，高钙血症被认为是由肿瘤分泌的PTHrP介导的。尽管已有几例输尿管癌伴恶性肿瘤体液性高钙血症的报道，但本病例被认为是首例与PTHrP升高相关的病例。
