Paraneoplastic hypercalcaemia in squamous cell carcinoma of the anus: first reported case

Cutaneous paraneoplastic syndrome associated with anal squamous cell carcinoma: a rare presentation of an uncommon cancer

Paraneoplastic syndromes associated with anal squamous cell carcinoma (scc) are rare. Erythema gyratum repens (egr) is a cutaneous paraneoplastic syndrome with distinctive characteristics. Here, we report the rare case of a 73-year-old woman with a chronic erythematous rash for 11 months associated with intense pruritus. She was treated with prednisone and antihistamines by dermatologists, but did not respond. The patient was subsequently seen in our clinic for unintentional weight loss and anorexia with intermittent nausea and vomiting. During further evaluation with imaging studies, upper endoscopy, and colonoscopy with biopsy, poorly differentiated anal scc was identified. Biopsies of the skin rash were characteristic of egr. She was treated using concurrent chemotherapy with 5-fluorouracil and mitomycin C and pelvic radiation (50.4 Gy in 28 fractions) for anal scc. She tolerated the treatment, and her rash faded, with resolution of the pruritus.

Hypercalcemia of Malignancy and Colorectal Cancer

Our aim is to describe the association between colorectal cancer (CRC) and humoral hypercalcemia of malignancy (HHM). Causes of hypercalcemia of malignancy include parathyroid hormone-related peptide (PTHrP) secretion, local osteolysis, calcitriol production and ectopic parathyroid hormone (PTH) secretion. Hypercalcemia of malignancy in patients with CRCs is a rare scenario. A patient with anal squamous cell carcinoma was admitted with hypercalcemia, suppressed PTH and hypophosphatemia. He was found to have metastatic anal squamous cell carcinoma to the liver. Further evaluation revealed elevated PTHrP and 1,25-dihydroxyvitamin D and low 25-hydroxyvitamin D. Over a 5-month course, the hypercalcemia responded poorly to bisphosphonates, transiently to prednisone, but showed marked improvement with chemotherapy. A review of English language publications in Pubmed and a reference search of retrieved articles revealed 29 cases of CRC causing PTHrP-mediated hypercalcemia. Most patients were middle-aged men (mean ± SD: 56.7 ± 13.4 years), with advanced metastatic cancer (85% with hepatic metastasis) and severe hypercalcemia (mean ± SD: 15.6 ± 1.9 mg/dL, 62% with Ca > 14). This condition is associated with high mortality (79%) and short survival (median 54.5 days, CI: 21 - 168). Despite being uncommon, HHM (PTHrP-mediated) should be considered in patients with metastatic CRC presenting with hypercalcemia. Clinicians should be aware that combined etiologies may be present, particularly in cases of resistant hypercalcemia. Treatment of the underlying malignancy is essential for calcium control.

Cancer-associated hypercalcaemia in squamous-cell malignancies: a survival and prognostic factor analysis

The aim of this study is to analyse survival and prognostic factors in patients diagnosed with squamous cell carcinoma (SCC) presenting a first episode of cancer-associated hypercalcaemia (CAH). Retrospectively, the authors reviewed data from 220 patients with biopsy proven SCC who presented a first episode of CAH. They were treated in a single centre between 1995 and 2007. The survival analyses were done using the Kaplan-Meier method and Cox analysis. The primary endpoint was the overall survival from the date of hypercalcaemia episode. Median age was 55 years. Median survival was 64 days (1-197). Three independent prognostic factors were identified: brain metastasis (hazard ratio (HR)=2.58 CI (1.03-6.45)), corrected calcaemia>3 mmol/l (HR=1.45 CI (1.05-2.01)) and hypoalbuminaemia (HR=1.48 CI (1.07-2.04)). Using these factors, the authors performed a bedside prognostic score. In conclusion, median survival in patients diagnosed with SCC and CAH is extremely poor. The bedside prognostic score that the authors developed can help to anticipate patients' prognosis and adapt the treatment. This score needs to be validated on an independent cohort.