Abstract:PTH-independent hypercalcaemia has a low prevalence in SCC patients. Hypercalcaemia is correlated with susceptibility to develop metastases in SCC. A possible mechanism is PTHrp hypersecretion by malignant keratinocytes.
“…PTHrP levels are hypothesized to reflect tumor burden and may be useful in monitoring response to treatment or tumor progression in select patients with HHM (2). The prevalence of PTH-independent hypercalcemia was noted to be 1.2% in patients with SCC, thus emphasizing the rare occurrence of this association between cutaneous SCC and hypercalcemia (18). Despite molecular similarity and data indicating that PTHrP analogues can mirror the effect of PTH in vitro, HHM differs significantly from primary hyperparathyroidism, as patients with HHM are less likely to manifest hypertension, renal calculi, band keratopathy, or osteopenia (19).…”
Section: Discussionmentioning
confidence: 96%
“…PTHrP has high affinity for the PTH/PTHrP receptor, through which it exerts its effects (9). PTHrP induces bone resorption and decreases bone formation, thereby affecting whole-body calcium distribution, resulting in hypercalcemia, while at the renal level, it stimulates phosphaturia and inhibits urinary calcium absorption (18). PTHrP levels are hypothesized to reflect tumor burden and may be useful in monitoring response to treatment or tumor progression in select patients with HHM (2).…”
Objective: To report a case of hypercalcemic crisis in an African American male who presented with a nonhealing ulcer which was later found to be squamous cell carcinoma.Methods: All relevant data, radiologic imaging, and pathology reports were reviewed in detail. An in-depth literature review for humoral hypercalcemia of malignancy and cutaneous squamous cell carcinoma was performed using MEDLINE.Results: A 58-year-old man with a history of chronic lymphedema presented with fever and a nonhealing left foot ulcer. Initial studies revealed acute kidney injury, anemia, and non-parathyroid hormone (PTH)-mediated hypercalcemic crisis (calcium, 17.7 mg/dL). A thorough work-up ruled out bone metastasis and confirmed increased PTH-related peptide, which is the hallmark of humoral hypercalcemia of malignancy (HHM). Hypercalcemia was initially managed with intravenous fluid hydration, bisphosphonates, and calcitonin. The patient had surgical resection of the left leg, and pathology revealed cutaneous squamous cell carcinoma. Hypercalcemia resolved completely after surgical resection of the tumor.
“…PTHrP levels are hypothesized to reflect tumor burden and may be useful in monitoring response to treatment or tumor progression in select patients with HHM (2). The prevalence of PTH-independent hypercalcemia was noted to be 1.2% in patients with SCC, thus emphasizing the rare occurrence of this association between cutaneous SCC and hypercalcemia (18). Despite molecular similarity and data indicating that PTHrP analogues can mirror the effect of PTH in vitro, HHM differs significantly from primary hyperparathyroidism, as patients with HHM are less likely to manifest hypertension, renal calculi, band keratopathy, or osteopenia (19).…”
Section: Discussionmentioning
confidence: 96%
“…PTHrP has high affinity for the PTH/PTHrP receptor, through which it exerts its effects (9). PTHrP induces bone resorption and decreases bone formation, thereby affecting whole-body calcium distribution, resulting in hypercalcemia, while at the renal level, it stimulates phosphaturia and inhibits urinary calcium absorption (18). PTHrP levels are hypothesized to reflect tumor burden and may be useful in monitoring response to treatment or tumor progression in select patients with HHM (2).…”
Objective: To report a case of hypercalcemic crisis in an African American male who presented with a nonhealing ulcer which was later found to be squamous cell carcinoma.Methods: All relevant data, radiologic imaging, and pathology reports were reviewed in detail. An in-depth literature review for humoral hypercalcemia of malignancy and cutaneous squamous cell carcinoma was performed using MEDLINE.Results: A 58-year-old man with a history of chronic lymphedema presented with fever and a nonhealing left foot ulcer. Initial studies revealed acute kidney injury, anemia, and non-parathyroid hormone (PTH)-mediated hypercalcemic crisis (calcium, 17.7 mg/dL). A thorough work-up ruled out bone metastasis and confirmed increased PTH-related peptide, which is the hallmark of humoral hypercalcemia of malignancy (HHM). Hypercalcemia was initially managed with intravenous fluid hydration, bisphosphonates, and calcitonin. The patient had surgical resection of the left leg, and pathology revealed cutaneous squamous cell carcinoma. Hypercalcemia resolved completely after surgical resection of the tumor.
“…In a single center study with 412 patients with cutaneous squamous cell carcinoma (SCC), Nicolae et al . reported a low PTH-independent hypercalcemia prevalence of 1.21% [7]. Furthermore, two cases with hypercalcemia-hyperleukocytosis paraneoplastic syndrome in cutaneous squamous cell carcinoma were described [8].…”
IntroductionWhile paraneoplastic syndromes in patients with malignant and metastasizing tumors are common, they are rarely associated with skin tumors showing predominantly local growth patterns. This case report relates to a patient with giant condyloma acuminatum, also called Buschke-Löwenstein tumor, with paraneoplastic hypercalcemia, who was successfully treated with conservative treatment.Case presentationThe patient in question is a 48-year-old German man with a giant periscrotal tumor. Before and during the therapy, two episodes of symptomatic hypercalcemia occurred, which were successfully treated by bisphosphonates, intravenous fluids and diuretics. No evidence of lytic bone affection was found.ConclusionsParaneoplastic hypercalcemia may occur in patients who have a Buschke-Löwenstein tumor. For patients, where surgery is not an option, established medical therapies like bisphosphonates may be useful in addition to diuretics and infusions.
“…The patient's tumour was deemed inoperable, and not amenable to systemic chemotherapy due to poor performance status; therefore, palliative radiotherapy was initiated. Learning points
Distant osseous metastases from cutaneous squamous cell carcinoma are rare and the underlying humoral mechanism involves parathyroid hormone-related peptide overproduction by the tumour 1. Intriguingly, low but detectable serum intact parathyroid hormone levels are also involved in the development of humoral hypercalcaemia of malignancy 2…”
Section: Descriptionmentioning
confidence: 99%
“…Distant osseous metastases from cutaneous squamous cell carcinoma are rare and the underlying humoral mechanism involves parathyroid hormone-related peptide overproduction by the tumour 1. Intriguingly, low but detectable serum intact parathyroid hormone levels are also involved in the development of humoral hypercalcaemia of malignancy 2…”
DESCRIPTIONAn 83-year-old man presented with hypercalcaemia (12.5 mg/dL, reference range 8-10.7 mg/dL) and acute renal failure. On physical examination, the patient was found to have a solid mass behind his left ear ( figure 1A). Histopathological examination disclosed squamous cell carcinoma with areas of necrosis. Serum phosphorus level was low (2 mg/ dL, reference range 2.7-4.5 mg/dL) and intact parathyroid hormone (iPTH) was also low (4.4 pg/mL, reference range 10-65pg/mL), whereas an elevated PTH-related peptide (PTH-rP) level was found (27 pg/mL, reference range 14-25pg/mL). Bone scan disclosed focal uptake in bilateral parietal skull highly suspicious of bone metastases (figure 1B), further assessed with brain MRI (figure 2). Acute renal failure and hypercalcaemia improved with intravenous fluids without need for bisphosphonate administration. No evidence of other primary solid malignancy was found on CT of the chest and abdomen/pelvis. Workup for multiple myeloma was negative. The patient's tumour was deemed inoperable, and not amenable to systemic chemotherapy due to poor performance status; therefore, palliative radiotherapy was initiated.
Learning points▸ Distant osseous metastases from cutaneous squamous cell carcinoma are rare and the underlying humoral mechanism involves parathyroid hormone-related peptide overproduction by the tumour. 1 Intriguingly, low but detectable serum intact parathyroid hormone levels are also involved in the development of humoral hypercalcaemia of malignancy.
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