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Selvananthan B, Fischer E, Lin R. Hypercalcaemia in gastrointestinal stromal tumour and sarcoidosis: a case report. BMC Nephrol 2024; 25:229. [PMID: 39030472 PMCID: PMC11264955 DOI: 10.1186/s12882-024-03655-2] [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: 01/26/2023] [Accepted: 06/25/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Hypercalcaemia is a common manifestation of sarcoidosis but is sparingly described in gastrointestinal stromal tumours (GISTs). We describe a case of acute kidney injury and hypercalcemia resulting from simultaneous diagnosis of GIST and sarcoidosis, the presentation of which has not yet been reported. CASE PRESENTATION A 61-year-old male presented with acute kidney injury and hypercalcemia, with elevated 1,25-dihydroxyvitamin D levels. Investigations demonstrated a large gastric antral mass which was resected and proven to be GIST. Histopathology of incidentally found liver nodules revealed non-necrotising epithelioid granulomas consistent with concomitant sarcoidosis. The hypercalcemia was successfully treated with bisphosphonate therapy, resection of the GIST and a four month course of corticosteroids, which was truncated due to a mycobacterial infection. CONCLUSIONS Our case report is the first to describe hypercalcemia due to GIST and biopsy-proven sarcoidosis, thereby raising the possibility of a common pathophysiological pathway relating the two entities. We review the literature describing the mechanisms of hypercalcaemia in GIST and the association between GIST and sarcoidosis.
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Affiliation(s)
| | - Eddy Fischer
- Department of Renal Medicine, Nepean Hospital, Sydney, NSW, Australia
| | - Raymond Lin
- Department of Renal Medicine, Nepean Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Trotter N, White J. Gastrointestinal stromal tumour-induced hypercalcaemia. BMJ Case Rep 2023; 16:e243613. [PMID: 37967927 PMCID: PMC10660897 DOI: 10.1136/bcr-2021-243613] [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] [Indexed: 11/17/2023] Open
Abstract
Hypercalcaemia is recognised as the most common oncological metabolic emergency, with several proposed underlying mechanisms. Nevertheless, hypercalcaemia has been rarely reported as a complication in patients with gastrointestinal stromal tumours (GISTs). GISTs are uncommon mesenchymal tumours of the gastrointestinal tract. There are only nine previous cases of hypercalcaemia occurring in patients with GIST reported in the literature. We report a case of a man in his 70s with a background of metastatic GIST on fourth-line treatment. The patient presented with new hypercalcaemia and acute kidney injury. Despite medical management, his calcium remained elevated and he deteriorated secondary to significant disease progression.
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Affiliation(s)
- Nicola Trotter
- Internal Medicine, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Jeff White
- Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
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Herrera-Martínez Y, Contreras González MJ, Pedraza-Arévalo S, Guerrero Martínez MDC, Rodrigo Martínez Á, González Menchen A, Blanco Molina MA, Gálvez-Moreno MA, Moreno-Vega AL, Luque RM, Herrera-Martínez AD. Calcitriol-Mediated Hypercalcemia, Somatostatin Receptors Expression and 25-Hydroxyvitamin D 3-1α- Hydroxylase in GIST Tumors. Front Endocrinol (Lausanne) 2021; 12:812385. [PMID: 35154010 PMCID: PMC8826724 DOI: 10.3389/fendo.2021.812385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Hypercalcemia is a common complication in cancer patients Mainly caused by Parathyroid hormone-related protein (PTHrP) secretion and metastasis. Calcitriol secretion is a rare source of hypercalcemia in solid tumors, especially in gastrointestinal stromal tumors (GIST). We present a case report of a female patient with a 23 cm gastric GIST that expressed somatostatin-receptors and presented with severe hypercalcemia due to calcitriol secretion. Calcium control was achieved with medical treatment before the use of targeted-directed therapies. Surgery was performed and allowed complete tumor resection. Two years later, patient remains free of disease. Molecular analysis revealed the mRNA expression of 25-hydroxyvitamin D3-1-hydroxylase (1αOHase) and vitamin-D receptors in the tumor cells, confirming the calcitriol-mediated mechanism. Furthermore, the expression of the endotoxin recognition factors CD14 and TLR4 suggests an inflammatory mediated mechanism. Finally, the expression of somatostatin-receptors, especially SST2 might have been related with clinical evolution and prognosis in this patient.
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Affiliation(s)
- Yiraldine Herrera-Martínez
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Nuclear Medicine Service, Virgen del Rocio University Hospital, Seville, Spain
| | - María José Contreras González
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Medical Oncology Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Sergio Pedraza-Arévalo
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, Spain
| | - Maria del Carmen Guerrero Martínez
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Internal Medicine Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Ángela Rodrigo Martínez
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Internal Medicine Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Alberto González Menchen
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Pathology Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Maria Angeles Blanco Molina
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Internal Medicine Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Maria Angeles Gálvez-Moreno
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Alberto L. Moreno-Vega
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Medical Oncology Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Raúl M. Luque
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBERobn), Cordoba, Spain
| | - Aura D. Herrera-Martínez
- Maimonides Institute for Biomedical Research of Córdoba, Cordoba, Spain
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
- *Correspondence: Aura D. Herrera-Martínez,
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Hart T, Sinitsky D, Shamsiddinova A, Rohatgi A. Refractory hypercalcaemia secondary to localised gastrointestinal stromal tumour. Ann R Coll Surg Engl 2018; 100:e136-e138. [PMID: 29658339 DOI: 10.1308/rcsann.2018.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Gastrointestinal stromal tumours are a rare form of intra-abdominal neoplasm derived from mesenchymal tissue, typically presenting with abdominal pain, anaemia or bleeding into the bowel or abdominal cavity. Hypercalcaemia is an unusual complication, having been documented in only seven previous patients, all of whom had advanced metastatic disease. We present a case of treatment-resistant hypercalcaemia in a patient with non-metastatic gastrointestinal stromal tumour, which resolved following excision of the tumour.
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Affiliation(s)
- T Hart
- Royal Brompton and Harefield NHS Trust , London , UK
| | - D Sinitsky
- Whipps Cross University Hospital, Barts Health NHS Trust , London , UK
| | - A Shamsiddinova
- East Kent University Hospitals NHS Trust , Canterbury, Kent , UK
| | - A Rohatgi
- Whipps Cross University Hospital, Barts Health NHS Trust , London , UK
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