Paraneoplastic hypercalcemia associated with uterine papillary serous carcinoma

The co-occurrence of leukemoid reaction and hypercalcemia in a patient with endometrial cancer: A case report and literature review

Paraneoplastic syndromes are rarely seen in gynecological tumors especially in endometrial cancer. Early identification of paraneoplastic syndromes plays a significant role in the treatment and prognosis of cancer. Here, we reported a rare case with endometrial cancer with a 2.7 cm × 2.2 cm × 3.4 cm lesion in the posterior cervix presenting leukemoid reaction and hypercalcemia as paraneoplastic syndromes simultaneously. During the progress of the endometrial cancer, her leukocyte level rose up to 60.7 × 109/L after anti-infection treatment. Meanwhile, the patient represented a series of severe clinical situation including hypercalcemia, hypokalemia, metabolic alkalosis. and respiratory failure. Finally, the patient died of respiratory circulatory failure 2 weeks later. In addition to symptomatic treatment, possible treatment targeted on the primary tumor as early as possible might help to improve the clinical prognosis.

Humoral hypercalcemia caused by uterine corpus carcinosarcoma consisting of squamous cell carcinoma in its epithelial component

Humoral hypercalcemia of malignancy (HHM) is a paraneoplastic syndrome primarily caused by a tumor-producing parathyroid hormone-related protein (PTH-rP). We describe the first reported case of a uterine carcinosarcoma causing HHM. A 70-year-old patient was transferred to our hospital for a uterine tumor accompanied by impaired consciousness. The laboratory tests indicated anemia, malnutrition, elevated serum calcium and elevated PTH-rP. Emergency surgery, including abdominal hysterectomy and bilateral salpingo-oophorectomy, was performed due to uncontrollable uterine bleeding. The pathological diagnosis was carcinosarcoma consisting of pure squamous cell carcinoma in its epithelial component. Postoperatively, chemotherapy with paclitaxel and carboplatin was performed. The patient had recurrent tumors at the para-aortic lymph nodes 11 months after the initial surgery and underwent a pelvic and para-aortic lymphadenectomy, which removed all of the recurrent tumors.

A case of groans, moans and stones with malignant undertones: Endometrioid carcinoma-associated hypercalcemia

Humoral hypercalcemia of malignancy is frequently observed in patients with solid tumors. However, few instances have been described involving patients with gynecological malignancies. We report a case of endometrioid carcinoma of the uterine corpus in a patient who initially presented with hypercalcemia. The elevated calcium levels were found to be the result of an increased serum concentration of parathyroid hormone-related peptide (PTHrP). PTHrP is commonly secreted by malignant cells and suppresses PTH. This case demonstrates that endometrial cancer should be considered in the differential diagnosis of patients presenting with symptomatic or asymptomatic hypercalcemia.

High-Grade Endometrial Carcinomas

High-grade endometrial carcinomas are a heterogeneous group of clinically aggressive tumors. They include FIGO grade 3 endometrioid carcinoma, serous carcinoma, clear cell carcinoma, undifferentiated carcinoma, and malignant mixed Müllerian tumor (MMMT). Epidemiologic, genetic, biologic prognostic and morphologic differences between these entities are striking in prototypic cases, yet substantial overlap exists and diagnostic criteria and therapeutic approaches that account for the group's diversity are currently insufficient. FIGO grade 3 endometrioid carcinoma demonstrates solid, trabecular or nested growth and may resemble poorly differentiated squamous cell carcinoma. Endometrioid glandular differentiation is usually focally present. Serous carcinoma usually displays papillary architecture but glandular and solid patterns may predominate. Tumor cells typically display diffuse and severe atypia. Clear cell carcinoma should be diagnosed by recognizing characteristic papillary or tubulocystic architecture with cuboidal tumor cells showing atypical but uniform nuclei. Cells with clear cytoplasm are frequently but not always present. On the other hand, clear cells may be encountered in endometrioid and serous carcinomas. Immunohistochemical stains for p53, p16, ER, PR, mib-1, hepatocyte nuclear factor 1β and pan-cytokeratin can be helpful in classifying these high-grade carcinomas. They should be used in concert with thorough morphologic examination, as part of a rational panel of markers and only in specific circumstances. Although these tumors may appear clinically and even morphologically similar, demographic and epidemiologic features as well as patterns of spread and treatment modalities differ.

Parathyroid hormone-related protein-secreting uterine endometrioid adenocarcinoma

The diagnosis of parathyroid hormone-related protein (PTHrP)-secreting metastatic uterine endometrioid cancer was made in a 32-year-old Japanese woman with humoral hypercalcemia of malignancy. The primary endometrial cancer had been removed, and the tumor was diagnosed as Grade 1 endometrioid adenocarcinoma with shallow myometrial invasion. Salvage chemotherapy (paclitaxel and calboplatin) was started from 5 months after surgery when recurrent tumors were detected in the peritoneum and liver. Despite the salvage chemotherapy, the tumor progressed and hypercalcemia became evident with elevated PTHrP whereas no bone metastasis was identified. To the best of our knowledge, this is the first reported case of hypercalcemia due to PTHrP secretion in uterine endometrioid adenocarcinoma.

Non-endometrioid carcinomas of the uterine corpus: a review of their pathology with emphasis on recent advances and problematic aspects

This review considers the clinical and pathologic features of the various histologic subtypes of endometrial carcinoma excluding those of pure endometrioid type, as the latter tumors were the subject of a previous contribution in the Journal (Vol. 9, No. 2). Non-endometrioid carcinomas, which account for about 10% of endometrial carcinomas, may pose a great array of problems in differential diagnosis, including their distinction not only from benign lesions but also endometrioid carcinoma and various tumors that may secondarily involve the uterine corpus. The most common subtypes are serous, mucinous, and undifferentiated. Rarer tumors are clear cell, squamous, transitional cell carcinomas, and a variety of poorly differentiated carcinomas with unusual forms of differentiation, such as hepatoid carcinoma, carcinomas with trophoblastic elements, and giant cell carcinoma. Mixed carcinomas, which are common, are also discussed, including those with a component of endometrioid carcinoma. The final section deals with endometrial involvement by metastatic tumors, lesions that, albeit rare, are sometimes neglected in the differential diagnosis of endometrial carcinomas. Important aspects emphasized are: (1) The potential for serous carcinoma to be mimicked by various forms of papillary endometrioid carcinoma. (2) The rarity of clear cell carcinoma and the greater frequency of clear cells in endometrioid carcinoma. (3) The frequency of mucinous epithelium in tumors of mixed cell type. (4) The frequency with which neoplastic mucinous epithelium originates from the endometrium. (5) The striking degree of differentiation of some squamous cell carcinomas. (6) The occasional predominance of non-endometrioid carcinomas (especially serous or undifferentiated carcinoma) within malignant mullerian mixed tumors. (7) The spectrum of reactive epithelial changes and other non-neoplastic abnormalities that may mimic serous or clear cell carcinoma.