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Matsuoka N, Katsuno T, Tagami G, Ishizuka K, Tsuzuki T, Ito Y. Granulocyte-colony stimulating factor producing cervical cancer with elevated levels of parathyroid hormone-related protein: a case report and literature review. CEN Case Rep 2024; 13:45-52. [PMID: 37227595 PMCID: PMC10834895 DOI: 10.1007/s13730-023-00788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 03/31/2023] [Indexed: 05/26/2023] Open
Abstract
Systemic effects associated with hormones and cytokines secreted by tumor cells can cause paraneoplastic syndrome. Leukemoid reactions and hypercalcemia are relatively common manifestations of paraneoplastic syndrome. Here, we describe the case of a 90-year-old woman who presented with leukocytosis and hypercalcemia and was diagnosed with granulocyte-colony stimulating factor (G-CSF)-producing cervical cancer with elevated levels of parathyroid hormone-related protein (PTHrP). The patient visited our hospital complaining of general fatigue and anorexia. On admission, she presented with marked leukocytosis, hypercalcemia, and an increase in C-reactive protein level. On the basis of abdominal magnetic resonance imaging and histopathological examination, the patient was diagnosed with cervical cancer. Additional tests confirmed elevated plasma levels of G-CSF, PTHrP, and serum interleukin-6. Immunostaining of pathological specimens of the uterine cervix showed expression of G-CSF in tumor cells. The patient was diagnosed with G-CSF-producing cervical cancer accompanied by elevation of PTHrP levels. As a treatment for hypercalcemia, discontinuation of oral vitamin D derivative and administration of saline and elcatonin were ineffective, and therapeutic intervention with zoledronic acid hydrate was required. Considering the patient's advanced age, surgical resection of cervical cancer was not performed. She died from congestive heart failure approximately 3 months after hospitalization. This case was indicated to be a paraneoplastic syndrome in which G-CSF and PTHrP-induced leukocytosis and hypercalcemia. To the best of our knowledge, there have been no reports of G-CSF-producing cervical cancer with elevated PTHrP levels, and our case is the first report.
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Affiliation(s)
- Naoya Matsuoka
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan.
| | - Genri Tagami
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Koki Ishizuka
- Department of Clinical Training Center, Aichi Medical University, Nagakute, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
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Yanagi M, Suda T, Oishi N, Kobayashi M, Matsushita E. Adenosquamous carcinoma of the gallbladder simultaneously producing granulocyte-colony-stimulating factor and parathyroid hormone-related protein. Clin J Gastroenterol 2023; 16:901-907. [PMID: 37598132 DOI: 10.1007/s12328-023-01841-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
We report a rare case of adenosquamous carcinoma of the gallbladder which simultaneously produces granulocyte-colony-stimulating factor (G-CSF) and parathyroid hormone-related protein (PTHrP), confirmed serologically and histologically. A 71-year-old man was examined for a gallbladder tumor with multiple lymph nodes and liver metastases. Histopathological evaluation by endoscopic ultrasound fine-needle aspiration revealed adenosquamous carcinoma of the gallbladder. Laboratory data showed markedly elevated white blood cell (WBC) count of 34,700 µL and corrected serum calcium level of 14.9 mg/dL. Serum G-CSF (191 pg/mL) and PTHrP (23.1 pmol/L) levels were high. Zoledronic acid and calcitonin were administered to treat hypercalcemia, which normalized serum calcium levels. Gemcitabine-cisplatin chemotherapy was started for cStage IVB gallbladder cancer. After chemotherapy initiation, WBCs showed a rapid downward trend; however, the patient suddenly developed acute respiratory distress syndrome; thus, chemotherapy was discontinued. Subsequently, WBC count increased again, and the patient's overall condition deteriorated. The patient died on day 27. Immunohistochemistry using autopsy specimens demonstrated patchy staining for G-CSF in the squamous cell carcinoma portion and diffuse and weak positive staining for PTHrP in the squamous cell carcinoma and poorly differentiated adenocarcinoma portions of the tumor, suggesting simultaneous G-CSF and PTHrP production by the tumor. This is the first report of a patient with gallbladder cancer with serological and histological evidence for G-CSF and PTHrP production.
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Affiliation(s)
- Masahiro Yanagi
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwamachi, Kanazawa, Ishikawa, 921-8105, Japan
| | - Tsuyoshi Suda
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwamachi, Kanazawa, Ishikawa, 921-8105, Japan.
| | - Naoki Oishi
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwamachi, Kanazawa, Ishikawa, 921-8105, Japan
| | - Masako Kobayashi
- Department of Pathology, Kanazawa Municipal Hospital, Kanazawa, , Ishikawa, Japan
| | - Eiki Matsushita
- Department of Gastroenterology, Kanazawa Municipal Hospital, 3-7-3, Heiwamachi, Kanazawa, Ishikawa, 921-8105, Japan
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Latincic S, Pavlov M, Vasiljevic J, Vasin D, Dimic-Cumic M, Micev M, Papovic M, Doskovic M, Bugarin S, Milosevic S, Kecmanovic D. Extreme Leukocytosis and Gangrenous Cholecystitis Associated with Cytoreductive Surgery and HIPEC-Treated Mucinos Ovary Cancer: Case Report and Literature Review. Clin Pract 2023; 13:1137-1145. [PMID: 37736938 PMCID: PMC10514799 DOI: 10.3390/clinpract13050102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023] Open
Abstract
Mucinous ovarian cancer occurs sporadically, with a frequency of approximately 3-5% among all subtypes of ovarian cancer. Extreme leukocytosis >40,000 and 50,000 has been described in most solid tumors and is associated with a poor prognosis, although there is a lack of literal data of its occurrence after cytoreductive surgery and HIPEC in the treatment of advanced mucinous ovarian cancer. There is higher risk of the occurrence of cholecystitis in oncology patients compared to the general population, although there is no formal evidence for this, and the association with ovarian cancer is accompanied by a relative risk of 1.38. Hypercalcemia-hyperleukocytosis is a syndrome associated with head and neck cancers, although, to our knowledge, it has not been described in mucinous ovarian cancer, especially after cytoreductive surgery and HIPEC.
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Affiliation(s)
- Stojan Latincic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Maja Pavlov
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Jovica Vasiljevic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Dragan Vasin
- Emergency Department, University Clinical Centre of Serbia, Pasterova 2, 11000 Begrade, Serbia;
| | - Maja Dimic-Cumic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Marjan Micev
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Milena Papovic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Miljan Doskovic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Stefan Bugarin
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Stefan Milosevic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
| | - Dragutin Kecmanovic
- Clinic for Digestive Surgery—First Surgical Clinic, University Clinical Centre of Belgrade, Koste Todorovica 6, 11000 Belgrade, Serbia; (S.L.); (M.P.); (M.D.-C.); (M.M.); (M.P.); (M.D.); (S.B.); (S.M.); (D.K.)
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Abukhiran I, Mott SL, Bellizzi AM, Boukhar SA. Paraneoplastic leukemoid reaction: Case report and review of the literature. Pathol Res Pract 2021; 217:153295. [PMID: 33341546 DOI: 10.1016/j.prp.2020.153295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We recently encountered a patient with unexplained hyperleukocytosis (105.4 K/μL at presentation), subsequently found to have colon cancer with a marked tumor-associated neutrophilic infiltrate; the leukocytosis abruptly improved after tumor removal. Paraneoplastic leukemoid reaction (PLR) is a rare entity, occurring due to tumor cytokine secretion (typically granulocyte-colony stimulating factor [G-CSF]). We describe a case and aggregate results of previously published cases. METHODS We reviewed the English-language literature for all prior reports of PLR, recording age, gender, histologic diagnosis, WBC count, G-CSF level, and overall survival. We analyzed clinicopathologic variables' impact on survival. RESULTS We identified 179 cases (mean age 64; 72 % M). Adeno-, squamous cell, sarcomatoid, and undifferentiated carcinomas accounted for >70 %. Esophagus, gallbladder, lung, liver, and pancreas were the most common primaries. At time of publication 81 % of patients had died, with mean overall survival of 4 months. There was no correlation between WBC count and G-CSF level. On univariate analysis, WBC count was the only variable associated with survival (P = 0.03). Patients with WBC counts >100 K/μL were twice as likely to die as those with counts from 11 K to 40 K/μL. CONCLUSIONS PLR, typically carcinoma-associated, is characterized by dismal prognosis. The WBC count is inversely related to survival. Knowledge of this phenomenon militates against protracted, expensive work ups. In malignant neoplasms with prominent neutrophilic stroma, the pathologist should correlate with the WBC count and, if markedly elevated (>40 K/μL), raise consideration for PLR.
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Affiliation(s)
- Ibrahim Abukhiran
- Department of Pathology, University of Iowa Hospitals and Clinics and Carver College of Medicine, Iowa City, IA, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics and Carver College of Medicine, Iowa City, IA, USA
| | - Andrew M Bellizzi
- Department of Pathology, University of Iowa Hospitals and Clinics and Carver College of Medicine, Iowa City, IA, USA.
| | - Sarag A Boukhar
- Department of Pathology, University of Iowa Hospitals and Clinics and Carver College of Medicine, Iowa City, IA, USA.
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Roh JL, Lee H, Choi SH, Nam SY, Kim SY. Tumor-related leukocytosis predictive of recurrence and survival in patients with oral cavity squamous cell carcinoma. Oral Dis 2019; 25:1511-1518. [PMID: 31165559 DOI: 10.1111/odi.13138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the prognostic values of tumor-related leukocytosis (TRL) as a reliable biomarker predictive of recurrence and survival after definitive surgery for oral cavity squamous cell carcinoma (OSCC). MATERIALS AND METHODS This retrospective study involved 322 patients who underwent tumor extirpation combined with neck dissection for treatment-naïve OSCC between 2006 and 2014. Multivariate binary logistic regression analyses were used to analyze the relationship between TRL and pathological variables. Cox proportional hazard regression analyses were used to find associations between factors and disease-free survival (DFS) or overall survival (OS). RESULTS TRL was significantly related to advanced disease status, tumor size, invasion depth, poor differentiation, and T and N classifications, resulting in increased post-treatment recurrence rate, particularly in the distant site. Multivariate logistic regression analyses showed that only the T classification was significantly associated with baseline TRL (p = 0.018). Multivariate analyses also showed that the tumor depth of invasion, pathological N classification, extranodal extension, and TRL remained the independent variables predictive of DFS and OS (all p < 0.05). TRL was related to a more than twofold increased risk of post-treatment recurrence and mortality. CONCLUSIONS TRL is associated with advanced tumor disease and increased recurrence and mortality in OSCC patients.
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Affiliation(s)
- Jong-Lyel Roh
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hojun Lee
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Choi
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Yuhl Nam
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yoon Kim
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lin TC, Liang KL, Lee LC, Hsu CY, Yen TT. Cancer-related hypercalcemia in oral cancer. Int J Oral Maxillofac Surg 2017; 47:685-691. [PMID: 29153824 DOI: 10.1016/j.ijom.2017.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/03/2017] [Accepted: 10/26/2017] [Indexed: 12/09/2022]
Abstract
Cancer-related hypercalcemia (CRH) is a critical paraneoplastic disorder in advanced cancer patients. In clinical practice, patients with CRH have a poor prognosis. The medical records of 3198 oral cancer patients with CRH diagnosed at Taichung Veterans General Hospital from 1 January 2003 to 31 December 2015 were reviewed. The criteria for patient enrolment were a diagnosis of hypercalcemia or the use of antihypercalcemia medication. Patients who met any of the following criteria were excluded: use of total parenteral nutrition, incomplete serum calcium data, and unknown date of death. The total incidence of CRH was 6.95‰ per year. A total of 91 patients were enrolled; their median survival time was 28 days. The patients were divided into two groups by survival time, with a cut-off point of 30 days. Reduced serum albumin, leucocytosis, and clodronate use had a statistically significant effect on survival in the univariate analysis (all P<0.05). Forty-five patients (49.5%) had recurrence of CRH, of whom nine died within 30days. These nine patients had a shorter interval to the first episode of CRH recurrence (median 13 days) than those who survived ≥30days (median 28 days) (P<0.001). It was observed that a short interval to the first episode of CRH recurrence is a poor prognostic factor.
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Affiliation(s)
- T-C Lin
- Division of Family Medicine, Dachien General Hospital, Miaoli, Taiwan
| | - K-L Liang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - L-C Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-Y Hsu
- Taiwan Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - T-T Yen
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Kuroshima T, Wada M, Sato T, Takano M, Makino S. G-CSF producing oral carcinoma with diffuse uptake of FDG in the bone marrow: A case report. Oncol Lett 2017; 15:1241-1245. [PMID: 29399178 DOI: 10.3892/ol.2017.7422] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/06/2017] [Indexed: 12/27/2022] Open
Abstract
A 78-year-old male patient was referred to the Department of Oral Surgery, Hokuto Hospital (Obihiro, Japan) for painless swelling on the left neck and tongue. Histopathological examination of a biopsy specimen resulted in a diagnosis of squamous cell carcinoma of the tongue. Imaging examinations revealed cervical lymph node metastases on both sides, along with diffuse uptake of 18F-fluorodeoxyglucose (FDG) in the bone marrow of the spine and pelvis. Hematologic tests revealed an increased white blood cell (WBC) count and serum concentrations of granulocyte colony stimulating factor (G-CSF). These findings suggested a G-CSF producing tumor, with fluctuations of WBC count, serum G-CSF concentration, and FDG uptake in the bone marrow, associated with tumor shrinkage and enlargement, an indicator of tumor status.
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Affiliation(s)
- Takeshi Kuroshima
- Oral and Maxillofacial Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Mayumi Wada
- Department of Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833 Japan
| | - Takehiko Sato
- Department of Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833 Japan
| | - Masashi Takano
- Department of Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833 Japan
| | - Shujiroh Makino
- Department of Oral Surgery, Hokuto Hospital, Obihiro, Hokkaido 080-0833 Japan
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Kaneko N, Kawano S, Matsubara R, Goto Y, Jinno T, Maruse Y, Sakamoto T, Hashiguchi Y, Iida M, Nakamura S. Tongue squamous cell carcinoma producing both parathyroid hormone-related protein and granulocyte colony-stimulating factor: a case report and literature review. World J Surg Oncol 2016; 14:161. [PMID: 27316348 PMCID: PMC4912775 DOI: 10.1186/s12957-016-0918-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Paraneoplastic syndrome generally results from tumor-derived hormones or peptides that cause metabolic derangements. Common metabolic conditions include hyponatremia, hypercalcemia, hypoglycemia, and Cushing's syndrome. Herein, we report a very rare case of tongue carcinoma presenting with leukocytosis and hypercalcemia. CASE PRESENTATION A 57-year-old man was admitted to our hospital with tongue squamous cell carcinoma (cT4aN0M0, stage IV). He underwent radical resection following preoperative chemoradiotherapy, but locoregional recurrence was detected 2 months after surgery. He presented with marked leukocytosis and hypercalcemia with elevated serum levels of granulocyte colony-stimulating factor (G-CSF) and parathyroid hormone-related protein (PTHrP). He was therefore managed with intravenous fluids, furosemide, prednisolone, elcatonin, and pamidronate. However, the patient died 1 month later of carcinomatous pleuritis following distant metastasis to the lung. Immunohistochemical analyses of the resected specimens revealed positive staining for PTHrP and G-CSF in the cancer cells. CONCLUSIONS In this case, it was considered that tumor-derived G-CSF and PTHrP caused leukocytosis and hypercalcemia.
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Affiliation(s)
- Naoki Kaneko
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shintaro Kawano
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ryota Matsubara
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuichi Goto
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Maxillofacial Diagnostic and Surgical Science, Department of Oral and Maxillofacial Rehabilitation, Course for Developmental Therapeutics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Teppei Jinno
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuyuki Maruse
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Taiki Sakamoto
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yuma Hashiguchi
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masakazu Iida
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Seiji Nakamura
- Section of Oral and Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Sundriyal D, Kumar N, Kumar G, Walia M. Livedo reticularis heralding hypercalcaemia of malignancy. BMJ Case Rep 2014; 2014:bcr2013201371. [PMID: 24832704 PMCID: PMC4024535 DOI: 10.1136/bcr-2013-201371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/04/2022] Open
Abstract
The term livedo reticularis is used to describe net-like purple rash usually on the lower limbs. It is an important clinical sign with diverse aetiologies. Hypercalcaemia is an uncommon but important clinical entity, sometimes associated with livedo reticularis. Generally, hypercalcaemia of renal failure and secondary hyperparathyroidism has been reported with this condition. We report a case of livedo reticularis heralding onset of hypercalcaemia of malignancy.
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Affiliation(s)
- Deepak Sundriyal
- Department of Medical Oncology, Dharamshila Hospital, New Delhi, India
| | - Naveen Kumar
- Department of Internal Medicine, PGIMER & Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Gaurav Kumar
- Department of Medicine, V.M.M.C. and Safdarjung Hospital, New Delhi, India
| | - Meenu Walia
- Department of Medical Oncology, Dharamshila Hospital, New Delhi, India
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10
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Chen YW, Chen IL, Lin IC, Kao SY. Prognostic value of hypercalcaemia and leucocytosis in resected oral squamous cell carcinoma. Br J Oral Maxillofac Surg 2014; 52:425-31. [DOI: 10.1016/j.bjoms.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/17/2014] [Indexed: 12/20/2022]
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11
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Wu CY, Huang CJ, Chiu YW, Huang CT, Chuang HY. A retrospective analysis of the factors associated with hypercalcaemia in patients with advanced cancer. Eur J Cancer Care (Engl) 2013; 23:695-700. [PMID: 24304462 DOI: 10.1111/ecc.12161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 11/27/2022]
Abstract
Hypercalcaemia, a common complication of advanced cancer, causes multiple clinical symptoms, deteriorates patients' quality of life, and is associated with poor prognoses. This study aimed to identify the factors that may be associated with hypercalcaemia in advanced cancer by retrospectively reviewing the medical records of patients (n = 404) admitted to the palliative ward of the Kaohsiung Medical University Hospital, Taiwan, from 2006 to 2008. Patients' demographics, clinical data and symptoms were recorded. Seventy-nine of 404 patients had hypercalcaemia (19.6%), predominant in cases of head-and-neck cancer and haematological malignancies (P < 0.05), but not in those of bone metastases. Hypercalcaemia was associated with consciousness disturbances and leucocytosis (P < 0.05). We recommend that ionised (corrected) calcium levels be monitored clinically in patients with advanced cancer especially when consciousness disturbances are noted, or when head-and-neck or haematological malignancies are present. Testing of free calcium levels is also recommended in patients with leucocytosis.
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Affiliation(s)
- C Y Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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12
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Kobayashi JI, Miyazaki A, Yamamot T, Nakamori K, Suzuki R, Kaneko T, Suzuki N, Hiratsuka H. Granulocyte colony-stimulating factor-producing squamous cell carcinoma of the lower gingiva: a case report. HEAD & NECK ONCOLOGY 2012; 4:35. [PMID: 22713692 PMCID: PMC3414787 DOI: 10.1186/1758-3284-4-35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 06/19/2012] [Indexed: 12/25/2022]
Abstract
The present study summarizes our experience in treating a patient with a suspected granulocyte colony-stimulating factor (G-CSF)-producing squamous cell carcinoma (SCC) of the lower gingiva, which is a rather rare entity. A 56-year-old woman underwent surgical excision of palate leukoplakia in 1996. In 2009, however, a leukoplakic superficial tumor was detected in the lower left gingiva, for which the patient underwent gingivectomy. This was subsequently diagnosed as SCC. The patient also underwent superselective arterial injection chemotherapy combined with radiotherapy, after local recurrence was observed. The patient was subsequently found to have bone metastasis. After chemotherapy combined with radiotherapy, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. Resection of the left femoral tumor and left total knee replacement were also performed. Computed tomography scan performed 1 month after the surgeries revealed multiple lung, liver, spine, and subcutaneous metastases. The patient also exhibited a sudden increase in her white blood cell (WBC) count and a fever that could not be alleviated, despite treatment with antibacterial drugs. A G-CSF-producing tumor was therefore suspected. Serum G-CSF level was high at 250 pg/ml. The patient's WBC count increased to 32 × 103/ml and her general condition suddenly deteriorated, and she died as a result of multiple organ failure. A final diagnosis of G-CSF-producing SCC of the lower gingiva was made based on the patient's clinical course.
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Affiliation(s)
- Jun-ichi Kobayashi
- Department of Oral Surgery, Sapporo Medical University School of Medicine, South 1,West 16, Chuo-ku Sapporo, 060-8543, Japan.
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Chapireau D, Adlam D, Cameron M, Thompson M. Paraneoplastic syndromes in patients with primary oral cancers: a systematic review. Br J Oral Maxillofac Surg 2010; 48:338-44. [DOI: 10.1016/j.bjoms.2009.08.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 08/03/2009] [Indexed: 12/11/2022]
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14
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Ben Said B, Maitre S, Perrot JL, Labeille B, Cambazard F. [Hypercalcemia-hyperleukocytosis paraneoplastic syndrome complicating cutaneous squamous cell carcinoma. Report of two cases]. Rev Med Interne 2010; 31:309-11. [PMID: 20167400 DOI: 10.1016/j.revmed.2009.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 07/08/2009] [Accepted: 08/13/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report two cases of hypercalcemia-hyperleucocytosis paraneoplastic syndrome complicating cutaneous squamous cell carcinoma. CASE REPORTS The first patient, a 50-year-old man, suffering for hidradenitis suppurativa for the past 20 years, was admitted for squamous cell carcinoma. Laboratory findings showed marked hypercalcemia and hyperleucocytosis. PTHrP serum level was increased. Bone scintigraphy was normal. There was evidence of pulmonary metastasis. Despite treatment the patient died of agranulocytosis. The second patient was a 60-year-old man who presented with several months enlarging left axillary tumour. He has been treated by surgery for a squamous cell carcinoma of the left hand, 6 months ago. Serum calcium and white cell bloods count were elevated. The diagnosis of metastatic lymph node of cutaneous squamous cell carcinoma was confirmed. There was evidence of pulmonary metastasis. Despite chemotherapy the patient died rapidly. CONCLUSION Hypercalcemia-hyperleucocytosis paraneoplastic syndrome is rarely described during the course of cutaneous squamous cell carcinoma. This syndrome seems to be related to hormones or cytokines secretion by the neoplasic cells including PTHrP and G-CSF. Some authors ascribe it a poor prognostic significance.
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Affiliation(s)
- B Ben Said
- Service de dermatologie, hôpital Nord, CHU St-Etienne, avenue Albert-Raimond, St-Priest-en-Jarez, France.
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15
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Toro C, Rinaldo A, Silver CE, Politi M, Ferlito A. Paraneoplastic syndromes in patients with oral cancer. Oral Oncol 2009; 46:14-8. [PMID: 19932048 DOI: 10.1016/j.oraloncology.2009.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 09/29/2009] [Accepted: 09/30/2009] [Indexed: 12/15/2022]
Abstract
The diagnosis of a paraneoplastic syndrome (PNS) may precede, follow or be concurrent with the diagnosis of a malignant tumor. There is increasing knowledge of association between PNS and head and neck cancers, but the relationship between oral cancer and paraneoplastic disease has not been previously investigated. PNS associated with head and neck cancer can be divided into six main groups: endocrine, cutaneous or dermatologic, hematologic, osteoarticular or rheumatologic, neurologic, and ocular syndromes. We have comprehensively reviewed the literature to evaluate the incidence of occurrence of PNS with oral cancer, and conclude that only endocrine and dermatologic PNS have been associated with oral cancer. Humoral hypercalcemia is the most frequent PNS related to oral cancer, and has a negative prognostic significance. Dermatologic PNS are less common, but when they occur, they may precede the diagnosis of the oral tumor. Awareness of these conditions is important for clinicians who deal with cancer.
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Affiliation(s)
- C Toro
- Department of Surgical Sciences, Maxillofacial Surgery Clinic, University-Hospital of Udine, Udine, Italy.
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16
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Nimonkar PV, Borle RM. Hypercalcemia in patients of oral squamous cell carcinoma. J Maxillofac Oral Surg 2009; 8:230-2. [PMID: 23139514 DOI: 10.1007/s12663-009-0056-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 08/11/2009] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study was performed to measure the total and ionic serum calcium levels and incidence of hypercalcemia in patients with Oral Squamous Cell Carcinoma (OSCC) and its clinical significance and relevance. MATERIALS AND METHODS A randomly selected sample of seventy patients of histologically confirmed Oral Squamous Cell Carcinoma (OSCC) at any of the standard clinical stages were included. Fasting blood samples were obtained for measuring serum calcium levels. The elevated values of serum calcium levels were correlated with clinical features of hypercalcemia to draw inference. RESULTS Total serum calcium was found to be elevated in 12 patients (17.4%) and serum ionic calcium was elevated in 3 patients (4.29%). CONCLUSION The data suggests that hypercalcemia occurred in advanced stages of oral squamous cell carcinoma and its management may be relevant in providing terminal care and prolonging the life span of the patients.
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Affiliation(s)
- P V Nimonkar
- Dept. of Oral and Maxillofacial Surgery, Datta Meghe Institute of Medical Sciences University, Wardha, India
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17
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Burzyantseva O, Dharmasena S, Jayawardena S, Rupanagudi VA, Krishnan P. Hypercalcemia-leukocytosis syndrome in a patient with cavitating squamous cell carcinoma of the lung. CASES JOURNAL 2009; 2:108. [PMID: 19183491 PMCID: PMC2646690 DOI: 10.1186/1757-1626-2-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 01/31/2009] [Indexed: 11/30/2022]
Abstract
Introduction Lung cancer is the leading cause of death among the cancers seen in the United States. Hypercalcemia and leukocytosis are two common paraneoplastic syndromes associated with lung cancer. Unfortunately patients presenting with Hypercalcemia- leukocytosis syndrome has a worse prognosis than patients presenting with lung cancer alone. Case presentation We present a 67 yr old Caucasian male with a history of active smoking presenting as pneumonia being diagnosed as cavitating squamous cell carcinoma of the lung with hypercalcemia-leukocytosis syndrome Conclusion There should be a high degree of suspicion to diagnose lung cancer in patients presenting with symptoms of paraneoplastic syndrome.
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Affiliation(s)
- Olga Burzyantseva
- Department of Medicine, Coney Island Hospital, 2601 Ocean Parkway, Brooklyn, NY 11235, USA.
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18
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Garcia-Arias A, Cetina L, Candelaria M, Robles E, Dueñas-González A. The prognostic significance of leukocytosis in cervical cancer. Int J Gynecol Cancer 2007; 17:465-70. [PMID: 17309562 DOI: 10.1111/j.1525-1438.2007.00816.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cervical cancer is a frequent tumor with established prognostic factors such as FIGO stage and hemoglobin levels among others. Despite the fact that paraneoplastic leukocytosis is relatively common in many solid tumors, only isolated cases of cervical cancer patients presenting this abnormality have been published; hence, the clinical significance of leukocytosis is unknown in this tumor type. Retrospective review on the medical records of 294 consecutive newly diagnosed and untreated locally advanced cervical cancer patients who received radiotherapy and concurrent cisplatin was conducted. Leukocytosis was defined as a persistent white blood cell count exceeding 10,800/microL, determined at least twice before commencing chemoradiation providing that patients were free of any active acute or chronic infection or any other condition known to elevate the leukocyte count. The frequency of leukocytosis and their correlation with clinicopathologic features were investigated, as well as their impact on tumor response and survival. Leukocytosis with a median value of 13,300/microL (11,100-28,800) was observed in 35 (11.9%) patients at diagnosis. Leukocytosis was statistically associated only with advanced stages. Clinical complete response was observed in 57% versus 86% of the patients with and without leukocytosis, respectively. In the univariate analysis, leukocytosis, stage, and hemoglobin levels were significant predictors of survival; however, only leukocytosis and the hemoglobin level remained significant predictors of survival in the multivariate analysis. Leukocytosis is common in cervical cancer patients and has a negative prognostic significance.
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Affiliation(s)
- A Garcia-Arias
- Division of Clinical Research, Instituto Nacional de Cancerología de México, UNAM, México
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Tsuchimochi M, Kameta A, Sue M, Katagiri M. Immunohistochemical localization of parathyroid hormone-related protein (PTHrP) and serum PTHrP in normocalcemic patients with oral squamous cell carcinoma. Odontology 2006; 93:61-71. [PMID: 16170479 DOI: 10.1007/s10266-005-0049-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Accepted: 03/20/2005] [Indexed: 11/30/2022]
Abstract
Cancer cells produce parathyroid hormone-related protein (PTHrP) in the early phase of malignancy development, before hypercalcemia occurs. The relationship between PTHrP and the clinicopathologic features of oral squamous cell carcinoma is poorly understood. We studied 60 patients (43 men, 17 women; mean age, 64.8 +/- 11.2 years) with primary oral squamous cell carcinoma, from whom pretreatment biopsy specimens were obtained. We examined the relationship among immunohistochemical PTHrP expression, serum PTHrP levels, clinical characteristics of the tumor, and histopathologic aspects of the tumor. The mean calcium concentration for the 60 patients was 9.1 +/- 0.4 mg/dl. No patients had laboratory evidence of hypercalcemia before treatment. Six patients had serum levels of C-terminal (C)-PTHrP higher than the normal level of 55.3 pmol/l. There were no significant differences in serum C-PTHrP levels according to TNM stages. Abundant positive immunoreactivity for anti-PTHrP (1-34) antibody was recognized diffusely in the whole cytoplasm of many tumor cells. Anti-PTHrP (38-64) antibody staining tended to localize as small granules in the cytoplasm, especially close to the nuclear periphery. There was no correlation between the serum C-PTHrP concentration and the intensity of either immunostain. The intensity of PTHrP was proportionally related to the degree of differentiation or extent of keratinization (P < 0.05) and the histologic malignancy grade of the tumor (P < 0.05), when using antibody against PTHrP (1-34), but not when using antibody against PTHrP (38-64). Serum C-PTHrP levels did not correlate with the intensity of cellular PTHrP expression and characteristics of the tumor at the initial patient visit. The fragment that includes PTHrP (1-34) may be involved in the differentiation of oral squamous cell carcinoma. The differences between immunoreactivities may have been due to differing tissue malignancies and the use of different antibodies. The results suggest the need for caution when interpreting immunoreactivities of PTHrP in malignancies.
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Affiliation(s)
- Makoto Tsuchimochi
- Department of Oral and Maxillofacial Radiology, The Nippon Dental University School of Dentistry at Niigata, 1-8 Hamaura-cho, Niigata 951-8580, Japan.
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20
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Tanaka K, Nibu KI. Laryngeal squamous cell carcinoma with ectopic production of granulocyte colony-stimulating factor and parathyroid hormone-related protein. Int J Clin Oncol 2005; 10:195-7. [PMID: 15990969 DOI: 10.1007/s10147-004-0465-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 11/25/2004] [Indexed: 01/12/2023]
Abstract
It is known that malignant tumors occasionally produce hormone-like substances. However, they rarely produce two or more kinds of hormonal factors simultaneously. We describe the clinical, biochemical, and immunohistochemical findings in a patient with squamous cell carcinoma of the larynx associated with leukocytosis and hypercalcemia, without bone metastasis. The serum granulocyte colony-stimulating factor (G-CSF) level was 222 pg/ml (normal, < 38 pg/ml), and decreased to 15 pg/ml after surgery. The serum parathyroid hormone-related protein (PTHrP) level was 5.6 pmol/l (normal, < 0.5 pmol/l), and this also decreased, to less than 0.5 pmol/l. G-CSF and PTHrP increased again with tumor recurrence. The production of G-CSF from the tumor was confirmed by immunohistochemical staining with monoclonal antibody against human recombinant G-CSF. The tumor was revealed to produce both G-CSF and PTHrP. In this article, we describe this very rare case of primary squamous cell carcinoma of the head and neck with the simultaneous ectopic production of more than one hormone-like substance.
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Affiliation(s)
- Kohtaroh Tanaka
- Department of Otolaryngology-Head and Neck Surgery, University of Tokyo, Tokyo, Japan.
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21
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Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M. Hypercalcemia-leukocytosis syndrome associated with lung cancer. Lung Cancer 2004; 43:301-7. [PMID: 15165088 DOI: 10.1016/j.lungcan.2003.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Revised: 08/26/2003] [Accepted: 09/02/2003] [Indexed: 02/06/2023]
Abstract
Hypercalcemia and leukocytosis are two of the most common paraneoplastic syndromes associated with various malignancies. Of note, concomitant manifestation of hypercalcemia and leukocytosis are occasionally observed in the same cancer patients. However, the relationship between these two paraneoplastic syndromes and clinical outcome is unclear. In the present study, we retrospectively investigated the occurrence of hypercalcemia (> or = 10.2 mg/dl after adjustment for serum albumin concentration), leukocytosis (> or = 14,000/mm3 with no evidence of infection) or both in lung cancer patients (1149 cases). There were 65 cases (5.7%) of hypercalcemia, 16 cases (1.4%) of leukocytosis and six cases (0.5%) of both hypercalcemia and leukocytosis at the time of first presentation. The occurrence of these two distinct paraneoplastic syndromes in the same patients was more frequent than could have been expected by chance alone (P < 0.001). There was a significant correlation between the hypercalcemia-leukocytosis syndrome and performance status (P = 0.002). Survivals of patients with hypercalcemia alone (median survival time: MST 3.8 months, n = 59), leukocytosis alone (MST 1.9 months, n = 10), and the hypercalcemia-leukocytosis syndrome (MST 1.5 months, n = 6) were significantly shorter than those without them (MST 9.5 months, n = 1074; P < 0.001). Moreover, survival of patients with the hypercalcemia-leukocytosis syndrome was significantly shorter than that of patients with hypercalcemia alone (P = 0.013). On the other hand, there was no significant difference in survival between the hypercalcemia-leukocytosis syndrome and leukocytosis alone (P = 0.47). Multivariate analysis of prognostic factors using the Cox proportional hazards model could not demonstrate that the hypercalcemia-leukocytosis syndrome had independent prognostic significance. In conclusion, our results suggest that the hypercalcemia-leukocytosis syndrome is an additional clinical entity of paraneoplastic syndrome and is an indicator for poorer outcome in lung cancer patients, although the frequency of the combined syndrome is very rare (0.5% of cases over a 10 year interval.
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Affiliation(s)
- Akio Hiraki
- Department of Medicine (II), Okayama University Medical School, Okayama, Japan.
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22
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Abstract
OBJECTIVE To present a case and to review the relationship between tumor production of parathyroid hormone-related protein (PTHrP) and hypercalcemia in oral squamous cell carcinoma (SCC), with emphasis on tongue cancer. METHODS We describe a patient with advanced, locally invasive SCC of the tongue in whom hypercalcemia developed as a result of PTHrP production by the tumor. In addition, the medical literature regarding PTHrP and hypercalcemia associated with malignant disease is reviewed. RESULTS A 65-year-old man, who was admitted to the hospital because of one episode of unresponsiveness, was found to have a large, necrotic, ulcerated lesion overlying the left mandibular area. After biopsy of the tumor and total body imaging, he was diagnosed with advanced, locally invasive, poorly differentiated SCC of the tongue, stage T4 N1 M0. On admission, the serum calcium concentration was 12.5 mg/dL (normal range, 8.5 to 10.7), and the serum albumin level was 2.2 g/dL (normal range, 3.5 to 5.5). The serum intact parathyroid hormone level was 26 pg/mL (normal range, 10 to 65); the PTHrP level was 13.1 pmol/L (normal, <1.3). Hypercalcemia attributable to production of PTHrP by the tongue SCC was diagnosed. Initial treatment of the hypercalcemia with vigorous hydration yielded a limited response. Intravenous administration of pamidronate initially decreased the serum calcium level to 5.2 mg/dL, but then it progressively increased to 8.6 mg/dL during the next 4 weeks. The patient refused further treatment and died after 1 month. CONCLUSION To our knowledge, this is the first case of hypercalcemia associated with SCC of the tongue in which the serum PTHrP level was measured and reported to be high. It should be measured in other similar cases.
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Affiliation(s)
- A Gavrila
- Division of Endocrinology and Metabolism, Hahnemann University Hospital, Philadelphia, PA, USA
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23
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Uemura Y, Nakata H, Kobayashi M, Harada R, Asahi Y, Taguchi H. Regulation of granulocyte colony-stimulating factor and parathyroid hormone-related protein production in lung carcinoma cell line OKa-C-1. Jpn J Cancer Res 2000; 91:911-7. [PMID: 11011119 PMCID: PMC5926444 DOI: 10.1111/j.1349-7006.2000.tb01034.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Previously we have established a clonal squamous cell carcinoma cell line OKa-C-1 derived from lung cancer of a patient with marked leukocytosis and hypercalcemia. OKa-C-1 cells simultaneously produce granulocyte colony-stimulating factor (G-CSF) and parathyroid hormone-related protein (PTHrP) at the single cell level and cause paraneoplastic syndromes in nude mice bearing the tumor. It is known that the production of G-CSF and PTHrP is individually regulated by inflammatory cytokines in various malignant cells. To investigate the common factors in the regulation of G-CSF and PTHrP production in OKa-C-1 cells, we examined the effects of some inflammatory agents [lipopolysaccharide (LPS), phorbol-12-myristate-13-acetate (PMA), tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1) beta and IL-6] on G-CSF and PTHrP production, by means of enzyme-linked immunosorbent assay (ELISA), immunoradiometric assay (IRMA) and quantitative reverse transcription-polymerase chain reaction (RT-PCR). TNF-alpha or IL-1beta induced both G-CSF and PTHrP production in the conditioned medium. TNF-alpha synergized with IL-1beta to significantly increase G-CSF production. In addition, TNF-alpha and IL-1beta strongly induced G-CSF mRNA with peaks at 2 and 6 h respectively. Although PTHrP production was also strongly induced by TNF-a PTHrP mRNA expression was more strongly induced by PMA than by TNF-alpha. Thus, TNF-alpha and IL-1beta could be common factors that individually and synergistically regulate G-CSF and PTHrP production in OKa-C-1 cells. Moreover, G-CSF and PTHrP production could be not only transcriptionally, but also posttranscriptionally regulated by other factors.
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Affiliation(s)
- Y Uemura
- Department of Internal Medicine, Kochi Medical School, Kohasu, Okocho, Nankoku, Kochi 783-8505, Japan.
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24
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LEUKOCYTOSIS ASSOCIATED WITH AND LOCALIZED BLADDER CANCER. J Urol 1999. [DOI: 10.1097/00005392-199905000-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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GEORGILIS KOSTIS, ATHANASSIADES PETER. LEUKOCYTOSIS ASSOCIATED WITH AND LOCALIZED BLADDER CANCER: RESOLUTION WITH RADIATION THERAPY. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68960-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- KOSTIS GEORGILIS
- From the Department of Clinical Therapeutics, University of Athens School of Medicine, “Alexandra” Hospital, Athens, Greece
| | - PETER ATHANASSIADES
- From the Department of Clinical Therapeutics, University of Athens School of Medicine, “Alexandra” Hospital, Athens, Greece
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26
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Affiliation(s)
- V Grill
- University of Melbourne, Department of Medicine, Australia
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27
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Hiraga T, Takada M, Nakajima T, Ozawa H. Effects of bisphosphonate (pamidronate) on bone resorption resulting from metastasis of a squamous cell carcinoma: report of an autopsy case and evaluation of bone resorbing activity in an experimental animal model. J Oral Maxillofac Surg 1996; 54:1327-33. [PMID: 8941184 DOI: 10.1016/s0278-2391(96)90492-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This study evaluated the ability of bisphosphonate to prevent bone resorption induced by metastatic tumor cells. MATERIALS AND METHODS Autopsy specimens of a bone metastasis from a woman with a primary squamous cell carcinoma of the tongue who developed multiple osteolytic lesions and hypercalcemia and was treated with pamidronate were studied histologically, histochemically, and ultrastructurally. In an animal experiment, cultured tumor cells (1 x 10(5)) obtained from a metastatic submandibular lymph node in the same patient were injected in the left ventricle of nude mice, and a resulting metastatic bone lesion was studied histologically and histochemically. RESULTS In the autopsy specimens, despite the presence of many resorption lacunae on bone surface, only a few small tartrate-resistant acid phosphatase (TRAPase)-positive cells were observed, and most of them were stained weakly and detached from the bone surface. In the animal experiment, 1 of 10 animals (10%) formed osteolytic bone metastasis, and many TRAPase-positive cells were observed histochemically. CONCLUSIONS Biphosphonate inhibits bone resorption induced by tumor, possibly by decreasing the number of osteoclasts and inhibiting their function.
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Affiliation(s)
- T Hiraga
- School of Dentistry, Niigata University, Japan
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28
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Asahi Y, Kubonishi I, Imamura J, Kamioka M, Matsushita H, Furihata M, Ohtsuki Y, Miyoshi I. Establishment of a clonal cell line producing granulocyte colony-stimulating factor and parathyroid hormone-related protein from a lung cancer patient with leukocytosis and hypercalcemia. Jpn J Cancer Res 1996; 87:451-8. [PMID: 8641981 PMCID: PMC5921125 DOI: 10.1111/j.1349-7006.1996.tb00245.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Squamous cell lung carcinoma cells obtained from a patient who presented with leukocytosis and hypercalcemia were transplanted into nude mice and a serially transplantable cell line, OKa-N-1, was established. The nude mice transplanted with OKa-N-1 cells displayed leukocytosis and hypercalcemia. Serum levels of granulocyte colony-stimulating factor (G-CSF) and parathyroid hormone-related protein (PTHrP) were both elevated in these mice. In vitro cultivation of this tumor cell line gave rise to a clonal cell line, OKa-C-1. Nude mice transplanted with the OKa-C-1 cell line also showed leukocytosis and hypercalcemia with high serum G-CSF and PTHrP levels. The culture supernatant of OKa-C-1 contained high levels of G-CSF and PTHrP. Immunohistochemical studies showed the expression of PTHrP in OKa-C-1 cells. Reverse transcription polymerase chain reaction revealed the presence of G-CSF and PTHrP mRNA in this cell line. Dexamethasone treatment inhibited the transcription of G-CSF and PTHrP genes. This new human squamous carcinoma cell line, OKa-C-1, would be useful for studying the mechanism of simultaneous production of G-CSF and PTHrP and their control in cancer patients with leukocytosis and hypercalcemia.
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Affiliation(s)
- Y Asahi
- Department of Medicine, Kochi Medical School, Japan
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29
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Furihata M, Sonobe H, Iwata J, Ido E, Ohtsuki Y, Asahi Y, Kubonishi I, Miyoshi I. Lung squamous cell carcinoma producing both parathyroid hormone-related peptide and granulocyte colony stimulating factor. Pathol Int 1996; 46:376-9. [PMID: 8809885 DOI: 10.1111/j.1440-1827.1996.tb03624.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An autopsy case of a 61 year old male with primary squamous cell carcinoma of the lung with associated marked leukocytosis and hypercalcemia is reported. High levels of serum parathyroid hormone-related peptide (PTHrP) and granulocyte colony stimulating factor (GCSF) were detected. The tumor cells distinctly showed positive cytoplasmic immunoreactions with anti-PTHrP and anti-GCSF antibodies. Marked granulocytosis and thin bony trabeculae lacking osteoblasts were observed in the vertebral bone. Calcium deposits were found in the proximal tubules of the kidneys. Infarcts were seen as a result of fibrin thrombosis of the splenic artery. The tumor was successfully transplanted into nude mice in which the high levels of serum PTHrP and GCSF were reproduced. These results indicate that the tumor simultaneously produced both PTHrP and GCSF causing the paraneoplastic syndromes of hypercalcemia and leukocytosis.
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Affiliation(s)
- M Furihata
- Second Department of Pathology, Kochi Medical School, Japan
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Abstract
The paraneoplastic syndromes are effects of cancer that occur at sites remote from the primary tumor and its metastases. Recognition of these disorders is important from both diagnostic and therapeutic viewpoints. The important paraneoplastic syndromes involving the endocrine, nervous, hematologic, and dermatologic systems are discussed in this article.
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Affiliation(s)
- S S Agarwala
- Division of Medical Oncology, University of Pittsburgh Medical Center, University of Pittsburgh Cancer Institute, Pennsylvania, USA
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Minotti AM, Kountakis SE, Stiernberg CM. Paraneoplastic syndromes in patients with head and neck cancer. Am J Otolaryngol 1994; 15:336-43. [PMID: 7978037 DOI: 10.1016/0196-0709(94)90132-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Paraneoplastic syndromes are distinct physiological disorders of malignancy that occur remote from a tumor site. A review of a number of paraneoplastic syndromes occurring in patients with head and neck cancer has been discussed. These syndromes can produce life-threatening sequelae in the patient with cancer. Understanding these syndromes may provide important clinical information to assist in the early detection of occult malignancy and in reducing the occurrence of tumor-associated morbidity.
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Affiliation(s)
- A M Minotti
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical School at Houston 77030
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