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Matsuoka N, Katsuno T, Tagami G, Ishizuka K, Tsuzuki T, Ito Y. Granulocyte-colony stimulating factor producing cervical cancer with elevated levels of parathyroid hormone-related protein: a case report and literature review. CEN Case Rep 2024; 13:45-52. [PMID: 37227595 PMCID: PMC10834895 DOI: 10.1007/s13730-023-00788-5] [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: 12/17/2022] [Accepted: 03/31/2023] [Indexed: 05/26/2023] Open
Abstract
Systemic effects associated with hormones and cytokines secreted by tumor cells can cause paraneoplastic syndrome. Leukemoid reactions and hypercalcemia are relatively common manifestations of paraneoplastic syndrome. Here, we describe the case of a 90-year-old woman who presented with leukocytosis and hypercalcemia and was diagnosed with granulocyte-colony stimulating factor (G-CSF)-producing cervical cancer with elevated levels of parathyroid hormone-related protein (PTHrP). The patient visited our hospital complaining of general fatigue and anorexia. On admission, she presented with marked leukocytosis, hypercalcemia, and an increase in C-reactive protein level. On the basis of abdominal magnetic resonance imaging and histopathological examination, the patient was diagnosed with cervical cancer. Additional tests confirmed elevated plasma levels of G-CSF, PTHrP, and serum interleukin-6. Immunostaining of pathological specimens of the uterine cervix showed expression of G-CSF in tumor cells. The patient was diagnosed with G-CSF-producing cervical cancer accompanied by elevation of PTHrP levels. As a treatment for hypercalcemia, discontinuation of oral vitamin D derivative and administration of saline and elcatonin were ineffective, and therapeutic intervention with zoledronic acid hydrate was required. Considering the patient's advanced age, surgical resection of cervical cancer was not performed. She died from congestive heart failure approximately 3 months after hospitalization. This case was indicated to be a paraneoplastic syndrome in which G-CSF and PTHrP-induced leukocytosis and hypercalcemia. To the best of our knowledge, there have been no reports of G-CSF-producing cervical cancer with elevated PTHrP levels, and our case is the first report.
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Affiliation(s)
- Naoya Matsuoka
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan
| | - Takayuki Katsuno
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan.
| | - Genri Tagami
- Department of Nephrology and Rheumatology, Aichi Medical University Medical Center, 17-33 Kawagoshi, Nikki, Okazaki, Aichi, 444-2148, Japan
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Koki Ishizuka
- Department of Clinical Training Center, Aichi Medical University, Nagakute, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
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Matsuzawa Adachi M, Sugawara H, Ishii A, Chiba E, Hamamoto K, Demitsu T, Yamada S. Malignancy-related Hypercalcemia Caused by Metameric Cutaneous Metastasis of Parathyroid Hormone-related Protein-producing Bladder Carcinoma with Squamous Cell Differentiation: An Autopsy Case of Cobb Syndrome. Intern Med 2023; 62:3075-3084. [PMID: 36858515 PMCID: PMC10641195 DOI: 10.2169/internalmedicine.0893-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/23/2023] [Indexed: 03/03/2023] Open
Abstract
A 74-year-old woman was admitted with hypercalcemia and prolonged disturbance of consciousness. The left buttock to the anterior aspect of the left thigh was swollen and erythematous, with a collection of 1.0-cm large, firm, elastic nodules distributed in a zosteriform pattern in the L1-L4 region. Based on autopsy findings, a very rare case of Cobb syndrome was diagnosed due to a spinal vascular malformation at the Th12-L4 level and L5 vertebral hemangioma. Cobb syndrome-associated cutaneous metastasis extending along the same metamere was complicated by immunohistochemically proven parathyroid hormone-related protein-producing advanced bladder carcinoma in this case.
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Affiliation(s)
- Michiko Matsuzawa Adachi
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Hitoshi Sugawara
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Akira Ishii
- Division of General Medicine, Department of Comprehensive Medicine 1, Saitama Medical Center, Jichi Medical University, Japan
| | - Emiko Chiba
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Japan
| | - Kohei Hamamoto
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Japan
| | - Toshio Demitsu
- Division of Dermatology, Department of Comprehensive Medicine 2, Saitama Medical Center, Jichi Medical University, Japan
| | - Shigeki Yamada
- Department of Pathology, Saitama Medical Center, Jichi Medical University, Japan
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Shimohama S, Oki K, Narita H, Mashima K, Yamada S, Adachi T, Kobayashi Y, Hirose S, Hoshino H. Trousseau's Syndrome Presenting as Multiple Cerebral Infarctions Caused by Mucin-producing Bladder Micropapillary Urothelial Cancer. Intern Med 2022; 61:97-101. [PMID: 34176838 PMCID: PMC8810238 DOI: 10.2169/internalmedicine.7477-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 70-year-old man with recurrent multiple cerebral infarctions under warfarin therapy who was finally diagnosed with Trousseau's syndrome resulting from advanced bladder cancer. A histological examination of the mesenteric lymph nodes revealed metastasis of micropapillary urothelial cancer with positive mucin markers CA125 and MUC1. Blood examinations also indicated elevated tumor markers, such as CA19-9 and CA125. To our knowledge, this is the first report of Trousseau's syndrome in a patient with bladder micropapillary urothelial cancer in which mucin involvement was clearly proven by histological and serological examinations.
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Affiliation(s)
- Sho Shimohama
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
| | - Koichi Oki
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
| | - Hidefumi Narita
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
| | - Kyoko Mashima
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
| | - Satoshi Yamada
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
| | - Tomohide Adachi
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
| | | | | | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
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Ling Y, Li Y, Zhang X, Dong L, Wang J. Clinical features of Trousseau's syndrome with multiple acute ischemic strokes. Neurol Sci 2021; 43:2405-2411. [PMID: 34564800 DOI: 10.1007/s10072-021-05619-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trousseau's syndrome or migrating thrombophlebitis can cause venous or arterial thrombosis; however, multiple acute ischemic strokes (MAIS) caused by Trousseau's syndrome are rare. The aim of this study was to analyse the clinical features of Trousseau's syndrome with MAIS and to improve the awareness and the knowledge of this disease. METHODS Clinical data from fifteen patients who were diagnosed as Trousseau's syndrome with MAIS in Rizhao People's Hospital from January 2017 to April 2020 were collected and analysed. The clinical data included the following: patients' basic information (including gender, age, underlying diseases, and tumour stage), laboratory results, imaging features, treatment regimens, and short-term prognoses were collected. RESULTS The mean age was 65.5 years, with thirteen males and two females. Most patients (11/15) had a history of smoking and (or) drinking. The average score of NIHSS was 2.13. 6 of the 15 patients first presented with ischemic stroke and then found the primary tumour. Most common types of primary tumour was lung cancer (11/15), and other types of primary tumour were gastric adenocarcinoma, renal cell carcinoma, oesophageal adenosquamous carcinoma, and cholangiocarcinoma (one in each). All the 15 patients showed different levels of increase of D-dimer. The increase in CRP appears in 10 of the 15 patients. Various tumour markers were increased in the 15 patients, especially for CYFRA-211, all the patients of which were higher than normal. All of the 15 patients had multiple vascular territory lesions in DWI, and most lesions were near the cortex areas. Only 4 of the 15 patients (26.7%) occurred with peripheral venous thrombosis. Thirteen patients were given low molecular heparin for anticoagulant therapy, of which 9 patients were improved in short-term while 4 patients were not. CONCLUSION Trousseau's syndrome with MAIS was associated with old-age male, smoking and (or) drinking history, low NIHSS score, increased D-dimer, CRP and tumour markers, and lesions near the cortex areas with multiple vascular territories in DWI. Patients with these features should be alert of malignant tumour. Most common types of primary tumour were lung cancer. Treatment with low molecular heparin may be effective in short term.
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Affiliation(s)
- Yitong Ling
- Department of Neurology, Rizhao People's Hospital, Rizhao, 276826, Shandong, China
| | - Yinye Li
- Department of Imaging, Donggang District People's Hospital of Rizhao, Rizhao, 276826, Shandong, China
| | - Xiaoyu Zhang
- 3Department of Emergency, Rizhao People's Hospital, Rizhao, 276826, Shandong, China
| | - Lihua Dong
- Department of Neurology, Rizhao People's Hospital, Rizhao, 276826, Shandong, China
| | - Jintao Wang
- Department of Neurology, Rizhao People's Hospital, Rizhao, 276826, Shandong, China.
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Pembrolizumab Treatment and Pathologic Therapeutic Evaluation for Granulocyte Colony-stimulating Factor-producing Bladder Cancer: A Case Report and Literature Review. J Immunother 2021; 43:134-138. [PMID: 32080020 DOI: 10.1097/cji.0000000000000311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF)-producing bladder cancer is a rare variant subtype of bladder cancer with a poor prognosis. Pembrolizumab has improved overall survival in bladder cancer and is widely used as a standard second-line treatment. However, no reports on G-CSF-producing cancer treated by pembrolizumab are available. We report a case of the pathologically evaluated antitumor effect of pembrolizumab, a programmed death-1 immune checkpoint inhibitor antibody, in G-CSF-producing bladder cancer. A 53-year-old male patient underwent 4 courses chemotherapy with a combination of gemcitabine and carboplatin before a radical cystectomy with ileal neobladder. Four months after the surgery, local recurrence was detected in the pelvis and therefore pembrolizumab was used. One week after its administration, the patient showed increased mucus in his urine. A computed tomography scan and cystoscopy revealed a fistula between the ileum and the neobladder. He subsequently underwent partial ileectomy and repair of the neobladder-ileum fistula. Pathology-diagnosed tumor response to pembrolizumab in the metastatic tumor showed predominant infiltration by lymphocytes, unlike that in the primary bladder cancer. The patient has shown complete response and no recurrence at 1 year after the beginning of treatment, and therapy is still continuing. Although many questions still remain regarding the treatment of G-CSF-producing bladder cancer, pathologic evaluation of the present case suggests that treatment with pembrolizumab may be one option for G-CSF-producing bladder cancer that has failed chemotherapy treatment, similar to non-G-CSF-producing bladder cancer.
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Kimura N, Tsuchiya A, Oda C, Kimura A, Hosaka K, Tominaga K, Hayashi K, Abé T, Umezu H, Terai S. Portal Vein Thrombosis Associated with Trousseau Syndrome due to Urinary Bladder Squamous Cell Carcinoma in a Liver Cirrhosis Patient. Intern Med 2020; 59:1971-1975. [PMID: 32448831 PMCID: PMC7492126 DOI: 10.2169/internalmedicine.4112-19] [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] [Indexed: 11/06/2022] Open
Abstract
A 75-year-old woman with liver cirrhosis was admitted for treatment of portal vein thrombosis (PVT). Computed tomography (CT) showed PVT, massive ascites, and multiple abdominal organ embolism. Blood tests revealed a decreased liver function (Child-Pugh grade C). Language impairment followed by progressive left hemi-paralysis was subsequently detected. Magnetic resonance imaging revealed multiple small acute cerebral infarctions and, on CT, a 30-mm bladder tumour; a biopsy specimen examination showed squamous cell carcinoma. Her general condition worsened rapidly, and the best supportive care was chosen. Our findings suggest that, in patients with PVT, Trousseau syndrome should be considered, even in cases of liver cirrhosis.
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Affiliation(s)
- Naruhiro Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Atsunori Tsuchiya
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Chiyumi Oda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Atsushi Kimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Kazunori Hosaka
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Kentaro Tominaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Kazunao Hayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Tatsuya Abé
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Hajime Umezu
- Division of Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Japan
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Aoyama KI, Tamura M, Uchibori M, Nakanishi Y, Arai T, Aoki T, Osawa Y, Kaneko A, Ota Y. Trousseau syndrome in a patient with advanced oral squamous cell carcinoma: a case report. J Med Case Rep 2019; 13:26. [PMID: 30691539 PMCID: PMC6350311 DOI: 10.1186/s13256-018-1833-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/03/2018] [Indexed: 12/21/2022] Open
Abstract
Background Trousseau syndrome is known as a variant of cancer-associated thrombosis. Trousseau syndrome commonly occurs in patients with lung or prostate cancer. Hypercoagulability is thought to be initiated by mucins produced by the adenocarcinoma, which react with leukocyte and platelet selectins to form platelet-rich microthrombi. This is the first report of Trousseau syndrome in a patient with oral cancer. Case presentation Here, we describe the case of a 61-year-old Japanese man diagnosed as having advanced buccal carcinoma (T4bN2bM1; the right scapula, erector spinae muscles, and the right femur), who experienced aphasia and loss of consciousness. Although magnetic resonance imaging showed cerebral infarction, carotid invasion by the tumor and carotid sheath rupturing, cardiovascular problems, and bacterial infection were not present, which indicated Trousseau syndrome. Conclusions Trousseau syndrome in oral cancer is rare, but we must always consider cancer-associated thrombosis in patients with advanced stages of cancer regardless of the primary site of the cancer and take steps to prevent it.
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Affiliation(s)
- Ken-Ichi Aoyama
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masashi Tamura
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Masahiro Uchibori
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yasuhiro Nakanishi
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Toshihiro Arai
- Department of Oral and Maxillofacial Surgery, National Hospital Organization Shizuoka Medical Center, 762-1 Nagasawa, Shimizu, Sunto, Shizuoka, 411-0905, Japan
| | - Takayuki Aoki
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yuko Osawa
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Akihiro Kaneko
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
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Hoshi S, Numahata K, Morozumi K, Katumata Y, Kuromoto A, Takai Y, Hoshi K, Bilim V, Sasagawa I. Bladder cancer metastasis producing beta-human chorionic gonadotropin, squamous cell carcinoma antigen, granulocyte-colony stimulating factor, and parathyroid hormone-related protein. IJU Case Rep 2018; 2:47-50. [PMID: 32743371 PMCID: PMC7292181 DOI: 10.1002/iju5.12036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/20/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction In urothelial cancer, several paraneoplastic syndromes can be triggered by the aberrant expression of hormones, growth factors or lymphokines by tumor cells. Case presentation A 71‐year‐old female patient underwent radical cystectomy for muscle‐invasive urothelial cancer. Shortly after the operation, the patient presented with a leukemoid reaction and hypercalcemia. Computed tomography scans revealed a rapidly progressing tumor on the left pelvic side, and serum levels of granulocyte‐colony stimulating factor, parathyroid hormone‐related protein, and beta human chorionic gonadotropin were elevated. The patient also tested positive for serum squamous cell carcinoma antigen. Hypercalcemia was successfully treated with denosumab. However, the patient's leukocyte counts steadily increased, her condition deteriorated and she passed away. Conclusion To the best of our knowledge, this is the first report of urothelial cancer that tested positive for four tumor markers. The findings support the idea that poorly differentiated bladder carcinomas can ectopically secrete multiple proteins causing pleiotropic paraneoplastic syndromes.
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Affiliation(s)
- Senji Hoshi
- Department of UrologyYamagata Tokushukai HospitalYamagataJapan
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Kenji Numahata
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Kento Morozumi
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Yuuki Katumata
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Akito Kuromoto
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Yuuki Takai
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Kiyotugu Hoshi
- Department of UrologyYamagata Tokushukai HospitalYamagataJapan
| | - Vladimir Bilim
- Department of UrologyKameda Daiichi HospitalNiigataJapan
| | - Isoji Sasagawa
- Department of UrologyYamagata Tokushukai HospitalYamagataJapan
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Kayukawa S, Ina K, Furuta R, Nishio T, Miyashita T, Umeda S, Kataoka T. Bladder squamous cell cancer accompanied by Trousseau's syndrome: a case report. Clin Case Rep 2018; 6:653-657. [PMID: 29636934 PMCID: PMC5889235 DOI: 10.1002/ccr3.1433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/15/2018] [Accepted: 01/29/2018] [Indexed: 12/21/2022] Open
Abstract
The association between thrombosis and cancer has been recognized since Trousseau's report in 1865. We present a case of bladder squamous cell carcinoma associated with multiple cerebral infarctions. This patient was diagnosed as having Trousseau's syndrome and received radiotherapy for bladder cancer treatment, along with anticoagulation therapy.
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Affiliation(s)
- Satoshi Kayukawa
- Department of Clinical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Kenji Ina
- Department of Medical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Ryuichi Furuta
- Department of Medical Oncology Nagoya Memorial Hospital Nagoya Japan
| | - Tomoko Nishio
- Department of Pathology Nagoya Memorial Hospital Nagoya Japan
| | | | - Shun Umeda
- Department of Urology Nagoya Memorial Hospital Nagoya Japan
| | - Takae Kataoka
- Department of Clinical Oncology Nagoya Memorial Hospital Nagoya Japan
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