Syndromes resulting from ectopic hormone-producing tumors

Neuroendocrine carcinoma in an adolescent with hypercortisolemia

We present a 16-year-old boy with weakness, hypercortisolemia, and markedly elevated adrenocorticotropic hormone. Computed tomographic imaging revealed hepatic lesions and a calcified pancreatic mass. Biopsy of the hepatic lesions revealed moderately differentiated neuroendocrine carcinoma. The primary tumor could not be determined. The patient received neoadjuvant chemotherapy with carboplatin and etoposide followed by therapeutic bilateral adrenalectomy and tumor debulking. Despite significant clinical improvement, restaging revealed progressive hepatic disease. The patient died 9 months after diagnosis. Autopsy revealed disseminated neuroendocrine carcinoma. The rarity of this tumor compels a cooperative investigational model involving pediatric and adult oncologists.

Hormone-producing capabilities of renal cell carcinomas. Correlation with ultrastructural findings

A retrospective study was conducted to evaluate ultrastructural aspects of hormone production by renal cell carcinomas. Fifteen renal cell carcinomas examined ultrastructurally were retrieved from the files. Six cases revealing abundant and diffusely distributed secretory granules in the neoplastic cells were found and correlated with clinical manifestations and laboratory findings. Five of these patients were hypercalcemic; the sixth patient was asymptomatic, and no abnormalities were detected in routine laboratory workup. Two additional cases showed focal aggregates of electron dense neurosecretory granules. These last 2 patients had no biochemical abnormalities and were entirely asymptomatic. The size and ultrastructural morphology of the cytoplasmic granules identified in the renal neoplasms were compared with the usual granular morphology associated with the specific hormones involved. Immunohistochemistry was used to confirm the parathormone hormone content of the granules in 7 of the 8 cases presented. The other case revealed granules with ultrastructural characteristics of prostaglandin granules.

Electrolyte and glucose metabolism in VX-2 carcinoma of the rabbit

Biochemical and other parameters in VX-2 carcinoma in rabbits were evaluated. VX-2 carcinoma not only produced hypercalcemia but also hypophosphatemia and 25-OH-vitamin D deficiency. An increased turnover of 25-OH-vitamin D seems likely. Serum parathyroid hormone and urinary cyclic AMP did not increase. Hypokalemia occurred in association with hypophosphatemia and lowered blood glucose within 1 week after tumor transplantation. At the end of the experiment glucose and insulin were both below the control range. It is concluded that VX-2 carcinoma in rabbits yields much more complex biochemical alterations than reported before on calcium metabolism.

Relationship between QRS width and the presence of neoplasm

This study examines the relationship between QRS width and the presence of neoplasia. The QRS width was measured in 236 consecutive ambulatory patients. The patients' body surface area, CBC, SMA 6, and SMA 12 were also recorded. There were 17 out of 34 (50%) patients with neoplasia in the group with QRS less than 0.08 seconds. There were only 19 out of 78 (24%) with neoplasia in the group with QRS greater than or equal to 0.08 seconds (P less than 0.01). We conclude that there is a higher incidence of neoplasia in patients with a QRS less than 0.08 seconds than in patients with a QRS greater than or equal to 0.08 seconds. This difference cannot be explained by age, body surface area, hemoglobin, or any variable in SMA 6 or SMA 12.

Systemic effects of hypernephroma

In a study of 30 patients with hypernephromas, 23 patients manifested systemic effects of the tumor, and in 5 of these, the systemic effects were the presenting feature that led to the diagnosis. In contrast to this, only 17 patients had urologic complaints, and no single patient in this study had the classic triad of hematurial, loin pain, and mass. Weight loss (52 per cent), pyrexia, and elevated sedimentation rate (36 per cent) were seen most frequently. Anemia was seen in 25 per cent of patients. Other features seen in this group wer abnormalities in liver function, elevated alkaline phosphatase, hypertension, erythrocytosis, and hypercalcemia. In the majority of instances, removal of tumor was associated with remission of these effects. The effects were classified as those of a general toxic nature, those due to normal or abnormal production of hormones, and those due to production of abnormal substances by tumor cells. The evaluation of these effects was useful in making an early diagnosis and in follow-up care.