Paraneoplastic Hypocalcemia Developed in Gastric Cancer Accompanied by Osteoblastic Metastasis

Okazaki, Jun; Muguruma, Naoki; Kitamura, Shinji; Kimura, Tooru; Okamoto, Koichi; Miyamoto, Hiroshi; Kishi, Kazuhiro; Bando, Yoshimi; Kondo, Takeshi; Endo, Itsuro; Abe, Masahiro; Takayama, Tetsuji

doi:10.2169/internalmedicine.56.8545

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…Typically, metastatic bone lesions with osteoblastic changes from gastric cancer are rare, with fewer than 20 cases having been reported to date [7]. A review of gastric cancers by Okazaki et al [8] identified that up to 80% of patients have poorly differentiated gastric cancers (signet ring cell carcinomas or poorly differentiated adenocarcinomas) [7]. The specific symptoms of osteoblastic metastasis of gastric cancers are hypocalcemia (in 28% of the cases) and elevated ALP levels.…”

Section: Discussionmentioning

confidence: 99%

“…Rapid proliferation of osteoclasts via expression of receptor activator of nuclear factor kappa-B ligand (RANKL) in gastric cancer cells plays an important role in the development of DC [10,11]. In addition, factors such as insulin-like growth factor (IGF), transforming growth factor-beta (TGF-β), bone morphogenetic protein (BMP), and platelet-derived growth factor (PDGF) play an important role in the development of cancer with the activation of osteoblastic lesions [7,9,12]. This process is different from the vicious cycle of osteolytic metastasis; it promotes the differentiation and function of osteoclasts and reduces osteoblast function [13].…”

Section: Discussionmentioning

confidence: 99%

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Bone Metastases from Gastric Cancer Resembling Paget’s Disease: A Case Report

Aiba

Nakazato²,

Matsuo³

et al. 2022

JCM

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Systemic osteosclerotic lesions are frequently caused by multiple bone metastases or systemic metabolic disorders. However, bone metastasis from gastric cancer is rare. Herein, we describe such a case, with radiographic and clinical findings resembling Paget’s disease. The patient was an 80-year-old Japanese woman with a history of early gastric cancer, treated by partial gastrectomy 2 years prior. The patient sought medical care for chronic low back pain. On imaging, systemic sclerotic lesions were observed throughout the spine and pelvis, with an increase in bone mineral density from 0.86 g/cm3 (2 years prior) to 1.38g/cm3 (current visit) in the lumbar spine. Elevated serum levels of osteoblastic and osteolytic markers were identified. A bone biopsy was used to confirm the diagnosis of metastatic gastric cancer. The patient was treated with TS-1 and denosumab, with normalization of abnormal metabolic markers and alleviation of the back pain. Bone metastasis is reported in only 10% of cases of gastric cancer and, thus, is relatively rare. Therefore, our case of gastric cancer recurrence presenting with mixed osteoblastic and osteolytic bone lesions similar to Paget’s disease is relevant to the report. Bone biopsy is necessary for an accurate diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bone Metastases from Gastric Cancer Resembling Paget’s Disease: A Case Report

Aiba

Nakazato²,

Matsuo³

et al. 2022

JCM

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“…[ 2 , 3 ] It has been reported in gastric and salivary carcinoma but not in bladder cancer. [ 4 , 5 ] Skeleton is one of the most frequent sites of metastasis after lung and liver [ 26 ] and the relative incidence of bone metastasis in bladder cancer is 40%. [ 6 ] Bone metastases increase the risks of morbidity and SREs such as hypercalcemia, bone pain, pathological fractures, cord compression, and bone marrow dysfunction and patients with bladder cancer and bone metastases generally have poorer prognosis with a median survival of 6 to 9 months.…”

Section: Discussionmentioning

confidence: 99%

“…Osteoblastic bone metastasis contributing to hypocalcaemia is typically described in prostate and breast cancer [ 2 , 3 ] and rarely in gastric and salivary carcinoma. [ 4 , 5 ] To date, hypocalcaemia resulting from osteoblastic bone metastases in bladder cancer has not been reported. Bone is a common site of metastasis and can occur in 40% of bladder cancer.…”

Section: Introductionmentioning

confidence: 99%

Severe and refractory hypocalcaemia secondary to osteoblastic bone metastases in bladder signet ring carcinoma: A case report and literature review

Zeng

Swee²

2022

Medicine

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Rationale: Symptomatic hypocalcaemia is uncommon, occurring in <2% of patients with malignancy. Osteoblastic bone metastasis as a cause of hypocalcaemia is rare and not reported in bladder cancer. Patient concerns: We report a case of refractory hypocalcaemia in a patient with bladder cancer with extensive osteoblastic bone metastases. A 64-year-old male with a history of signet ring bladder carcinoma with osteoblastic bone metastases presented with severe hypocalcaemia with corrected calcium of 1.64 (2.09–2.46) mmol/L as well as hypomagnesemia and hypophosphatemia. He was previously treated with chemotherapy and immunotherapy. Denosumab was also initiated for the prevention of skeletal-related events. Diagnoses: Additional investigations showed significantly elevated bone formation markers N-terminal propeptide of type I procollagen and alkaline phosphatase. Chest radiography and computed tomography scan also demonstrated extensive areas of sclerotic bone lesions suggestive of osteoblastic bone metastases. He was diagnosed with severe hypocalcaemia secondary to osteoblastic bone metastases and partly to denosumab, vitamin D deficiency, and hypomagnesemia. Interventions: He was treated aggressively with calcium and vitamin D replacement. Outcomes: Despite prolonged intravenous calcium replacement and high doses of oral calcium, cholecalciferol, and calcitriol replacement, he had persistent hypocalcaemia with calcium levels ranging from 1.8 to 1.9 mmol/L. He died 4 months after his admission. Lessons: Osteoblastic bone metastases lead to an increased influx of calcium and phosphate into the bone leading to hypocalcaemia and should be considered as a differential in severe and refractory hypocalcaemia. It is rare and has not been described in bladder cancer. Precaution should be taken upon the initiation of antiresorptive in patients with osteoblastic bone metastases.

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“…This alteration is believed to be secondary to the production of parathyroid hormone-related protein (PTH) by neoplastic cells (BERGMAN, 2012;MIRRAKHIMOV, 2015). Hypocalcaemia was related to the likely occurrence of hypomagnesemia, vitamin D deficiency, massive cell lysis, osteoblastic metastasis, or low levels of PTH (FAROLFI et al 2015;OKAZAKI et al, 2017).…”

Section: Case Reportmentioning

confidence: 99%