Combined Hepatocholangiocarcinoma Associated with Humoral Hypercalcemia of Malignancy and Chronic Inflammatory Demyelinating Polyneuropathy

Abstract

Paraneoplastic syndromes are often a diagnostic challenge to doctors and may have a heterogeneous presentation, including humoral hypercalcemia of malignancy (HHM), most commonly caused by squamous cell cancer and renal, ovarian, endometrial, and breast cancer. Chronic inflammatory demyelinating polyneuropathy (CIDP) has been described in patients affected by several types of cancer, especially hematologic malignancies, and a possible paraneoplastic pathogenesis of this neurological disease has been suggested. This report describes a 56-year-old man with a history of CIDP diagnosed 3 months earlier and persistently elevated aminotransferases for 18 months who was admitted to our internal medicine unit with abdominal pain, fatigue, and severe hypercalcemia with low serum intact parathyroid hormone. Parathyroid hormone-related protein (PTH-rP) was markedly high. Liver imaging showed a large hepatic mass in the right lobe, and percutaneous ultrasound-guided biopsy revealed histopathological findings consistent with a combined hepatocholangiocarcinoma (CHCC). We supposed that both HHM and CIDP could represent a paraneoplastic manifestation of CHCC.

Disruption of Intracellular Calcium Homeostasis as a Therapeutic Target Against Trypanosoma cruzi

“…Reported amiodarone cardiotoxicity is not related to Ca 2+ homeostasis but rather to blockade of potassium channels, which may lead to significant bradycardia and marked prolongation of the QT interval, and ultimately to the induction of polymorphic ventricular arrhythmias (Colunga-Biancatelli et al, 2019). Nevertheless, such events are very rare and usually multifactorial, with amiodarone still exhibiting the lowest proarrhythmic action when compared to other antiarrhythmic agents.…”

Chronic inflammatory demyelinating polyneuropathy caused by hepatocellular carcinoma

“…All patients in the reported cases were not candidates for radical surgical resection and were treated with chemotherapy, transcatheter arterial embolisation or radiofrequency ablation. In one of the cases, the cancer was diagnosed at advanced stages and palliative care was initiated 14. In the present case, CIDP diagnosis was made 1 year following onset of the neurological symptoms, and the diagnosis of HCC was then made 2 months following CIDP diagnosis.…”

“…While some of the aforementioned regimens quell the immune response, progression and relapse have been seen in around 50% of cases 10. Five previous cases were described in the literature regarding the occurrence of CIDP in the context of HCC 9 10 14–18. In four of them, the paraneoplastic syndrome preceded the diagnosis of the cancer by months, and symptoms of CIDP resolved in response to medical treatment alone 15–18.…”

Recurrent distal cholangiocarcinoma and humoral hypercalcemia of malignancy: report of a rare case and literature review

“…The PTHrP concentrations were reported for 17 of the 25 patients. Units of PTHrP other than pmol/L were used for four patients [17,19,20,25] and the PTHrP concentrations were not reported for the other four patients [10,18,21,23]. Therefore, these patients were excluded from the assessment of PTHrP concentration.…”

“…Therefore, these patients were excluded from the assessment of PTHrP concentration. In addition, patients for whom survival times were not reported or who were still alive at the time of publication were excluded from the assessment [4,16,17,20,21,25,26].…”