A case of endometrial adenocarcinoma associated with the humoral hypercalcemia of malignancy.
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Hypercalcemia associated with cancer is a paraneoplastic syndrome that mainly occurs in patients with an advanced stage of malignancy. It is suggested that the primary factor is parathyroid hormone related protein (PTHrP). We report a patient with prolonged hypercalcemia associated with an endometrial carcinoma whose serum calcium and PTHrP concentrations were normalized by a semiradical hysterectomy. A 58-year-old Japanese woman of 3-gravidity and 3 parity with a history of polyuria, thirst, general fatigue and precordial pain was admitted to the department of internal medicine of our hospital. Following menopause at the age of 48 years, she had an episode of postmenopausal bleeding but did not consult a physician. Serum calcium (corrected for albumin) was 16.5 mg/dl, intact-PTH was below minimum detection, and the level of PTHrPN-terminal was elevated (14.2 pmol/ml). Therefore, it was concluded that the hypercalcemia belonged to the category of humoral hypercalcemia of malignancy (HHM). X-ray examinations revealed no involvement in the bones, the cervical smear test showed class V, and the endometrial and endocervical curettage revealed an endometrioid adenocarcinoma. Modified radical hysterectomy, bilateral salpingo-oophorectomy and systemic pelvic lymphadenectomy were performed. The uterus was about the size of a newborn infant's head and a microscopic examination confirmed endometrioid adenocarcinoma stage III c, grade 3. Moreover, sections of the patient's tumor showed positive intracytoplasmic staining for PTHrP by an immunohistochemical method. The operation resulted in a rapid decrease in serum PTHrP levels(3.5 pmol/ml) and 2 days later, the serum calcium concentrations decreased (10 mg/di). It was concluded that the serum PTHrP and calcium levels were useful for the appropriate management of this patient. She was discharged after 3 courses of chemotherapy following the operative therapy. However, she was re-admitted to our hospital because a pelvic mass suggested recurrence about 5months later. She died of multiple organ failure despite of chemotherapy about 10 months from the previous operation. [Adv. Obstet. Gynecol., 52 (6): 778-782, 2000 (H.12.11)]
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