肋骨および腰椎骨への転移を伴った舌癌患者においてみられた著明な高カルシウム血症と白血球増多症 : 患者腫瘍のヌードマウスへの移植による高力ルシウム血症, および白血球増多症の再現

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A 41-year-old man was seen in August, 1984 with a 3.6×1.6×2.8 squamous cell carcinoma (T2N1M0) on the right side edge of his tongue. He was effectively treated with irradiation and chemotherapy for the primary lesion and with surgery for the neck metastases. Several months later, however, he complained of severe chest and back pain, which probably resulted from metastatic foci at second rib and lumbar spine, with concomitant increases in serum calcium level (8.8meq/<I>l</I>) and white blood cell count (180, 000/mm<SUP>3</SUP>, >96% granulocytes). Elcitonin (80 MRC U, twice a day, im) greatly reduced pain but failed to reverse the hypercalcemia. Mithramycin (25μg/kg, single injection) demonstrated a strong hypocalcemic effect. Serum levels of parathyroid hormone and 1, 25 dihydroxyvitamin D<SUB>3</SUB> and nephrogenous cyclic AMP were all within normal range throughout entire clinical course.<BR>Metastatic tumors of second rib obtained at autopsy were successfully implanted into athymic nude mice. Animals bearing the tumor showed marked hypercalcemia (8 meq/<I>l</I>) and leukocytosis (300, 000/mm<SUP>3</SUP>, >95% granulocytes) similar to those of the patient. Increases in serum calcium level and white blood cell count paralleled an enlargement of the tumor. Surgical excision of the tumor resulted in dramatic falls of serum calcium level and white blood cell count to normal levels. Recurrence of the tumor reproduced hypercalcemia and leukocytosis. Histologic examination demonstrated osteoclastic bone resorption at the endosteal surfaces of femur of tumor-bearing nude mice.<BR>These results indicate that hypercalcemia and leukocytosis seen in the patient and nude mice might be attributable to not only bone metastasis but also a release of humoral factors by the tumor.

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