Humoral Hypercalcemia in Uterine Cancers: A Case Report and Literature Review

Hypercalcemia of Malignancy: An Atypical Presentation of Endometrial Carcinoma

Hypercalcemia of malignancy associated with lung, gastrointestinal, and hematologic malignancies is well-described in the literature but has rarely been reported with gynecologic cancers. Even among gynecologic malignancies represented in literature with hypercalcemia, there are only a handful from endometrial carcinoma. Here we describe an atypical case of a patient with endometrial carcinoma who presented with symptomatic hypercalcemia. This case report investigates the atypical presentation of an endometrial carcinoma.

Parathyroid Hormone Related Peptide Hypercalcemia as a Presentation of Endometrial Clear Cell Carcinoma

Hypercalcemia is a frequent complication of solid tumors and hematologic malignancies yet is only rarely associated with endometrial clear cell carcinoma. Here we report on a 70-year-old female who presented in the context of hip fracture and was incidentally found to have humoral hypercalcemia of malignancy secondary to endometrial clear cell carcinoma. This rare association makes endometrial cancer one of the differential diagnoses to be considered when assessing incidentally found symptomatic or asymptomatic hypercalcemia in the appropriate patient population.

Acute pancreatitis with hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome: A case report and review of literature

BACKGROUND

Although acute pancreatitis associated with hyperparathyroidism has occasionally been reported, acute pancreatitis with metabolic encephalopathy caused by hyperparathyroidism combined with paraneoplastic syndrome is an extremely rare entity and poorly described in the literature.

CASE SUMMARY

We present a case of a 56-year-old female with upper abdominal discomfort and intermittent nausea and vomiting for 1 wk, without apparent abdominal pain or bloating, no jaundice and decreased blood pressure at the outset. The patient was ultimately diagnosed with moderately severe acute pancreatitis (according to the revised Atlanta classification of acute pancreatitis) combined with metabolic encephalopathy secondary to hypercalcemia caused by primary hyperparathyroidism associated with paraneoplastic syndrome. After active treatment of acute pancreatitis, massive fluid resuscitation, resection of parathyroid and uterine malignant tumors, neoadjuvant chemotherapy and other treatments, her serum calcium eventually returned to the normal level. The patient was successfully discharged from hospital.

CONCLUSION

This is the first case of acute pancreatitis caused by primary hyperparathyroidism associated with paraneoplastic syndrome.

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.

Parathyroid hormone related protein (PTHrP)-mediated hypercalcemia in malignancy associated with anti-PD-1 immune checkpoint inhibitor treatment and related inflammatory reactions

Over the last decade, the breakthrough of immune checkpoint inhibitors has revolutionized cancer therapeutics, an enterprise not devoid of a novel constellation of unique immune-related adverse events. In this article, we present the first two patients, one with metastatic urothelial bladder cancer and another one with inoperable non-small squamous cell lung carcinoma, with immune-related parathyroid hormone related protein (PTHrP)-mediated hypercalcemia concurrent with immune-related pneumonitis following administration of anti-PD-1 monoclonal antibody nivolumab. The second patient present immune-related colitis as well. In both patients the hypercalcemia developed when cancer was in remission, rendering unlikely the diagnosis of humoral hypercalcemia of malignancy. The time of onset of PTHrP-mediated hypercalcemia-11 weeks and 15 weeks after initiation of nivolumab for the first and second patient respectively- insinuated the immune-related origin of PTHrP. The concurrent immune-related pneumonitis raised the question of whether the immune-related inflammatory milieu in the context of pneumonitis could be the source of the immune-related PTHrP. In conclusion, increased awareness of nivolumab-related hypercalcemia -an extremely rare immune-related adverse event- could enable the identification of immune-related elevation of PTHrP. Moreover, our cases provide the rationale for further research in pursuit of not only the source of immune-related PTHrP expression, but also of a causative link connecting the inflammatory milieu of immune-related pneumonitis and/or immune-related colitis with PTHrP-mediated hypercalcemia. Finally, the correlation of immune-related adverse events observed herein with response to nivolumab is in line with previous reports, necessitating further consolidation.