Korean J Gastroenterol.  2015 Aug;66(2):122-126. 10.4166/kjg.2015.66.2.122.

Complete Tumor Resection for a Hepatocellular Carcinoma Secreting Parathyroid Hormone-related Peptide

• Kim EK
• Kim JS
• Shin KC
• Lee GT
• Han CJ
• Kim SB
• Ku YH

• KMID: 2373325
• DOI: http://doi.org/10.4166/kjg.2015.66.2.122

Abstract

Hepatocellular carcinoma (HCC) is the fifth most common cancer in Korea. Diverse paraneoplastic syndromes can occur in patients with HCC, but parathyroid hormone-related peptide (PTH-rP)-induced hypercalcemia is uncommon. Hypercalcemia due to PTH or particularly PTH-rP-secreting HCC is associated with poor outcomes. We report a 71-year-old man who presented with symptoms of vague abdominal discomfort, somnolence, lethargy, nausea, vomiting, and weight loss. Imaging studies revealed a large HCC without metastasis. The laboratory findings showed elevated serum calcium level, low intact parathyroid hormone (iPTH) level and elevated PTH-rP level. These results led to a diagnosis of a PTH-rP-secreting HCC and paraneoplastic hypercalcemia. After emergency management of the hypercalcemia, the patient underwent an extended right hemihepatectomy with cholecystectomy. One year after the surgery, he is alive with normal calcium, PTH-rP, and iPTH levels. This case demonstrates that the rare phenomenon of life-threatening hypercalcemia caused by HCC should not be overlooked. These symptoms offer a good opportunity to diagnose HCC early. Radical tumor resection makes it possible to cure patients with PTH-rP-secreting HCC.

Keyword

Hepatocellular carcinoma; Parathyroid hormone-related protein; Paraneoplastic syndromes

MeSH Terms

Aged
Carcinoma, Hepatocellular/metabolism/pathology/*surgery
Humans
Liver Neoplasms/metabolism/pathology/*surgery
Magnetic Resonance Imaging
Male
Parathyroid Hormone-Related Protein/metabolism/secretion
Positron-Emission Tomography
Tomography, X-Ray Computed
Parathyroid Hormone-Related Protein

Figure

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  Fig. 1. Hepatocellular carcinoma at the time of diagnosis. A 13-cm tumor is visualized in the right hepatic lobe.

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  Fig. 2. Immunohistochemistry of the tumor specimen. (A) Microscopically tumor cells show trabecular growth patterns separated by sinusoids (H&E, ×400). (B) Positive staining for glypican-3 (×400). (C) Negative staining for CK19 (×400). (D) Negative staining for parathyroid hormone (×400).

Reference

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