Severe Hypercalcemia as an Initial Presenting Manifestation of Hepatocellular Carcinoma

Ghobrial, Michel W.; George, John E.; Mannam, Sunitha; Henien, Samia R.

doi:10.1155/2002/651582

Cited by 19 publications

(11 citation statements)

References 15 publications

(24 reference statements)

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“…Secretion of PTH-rP has been described in patients with cancer of the lung, esophagus, kidney, breast, head, or neck, and even in some types of lymphoma. Hypercalcemia was found in 5-7% of patients with HCC, and in some cases it may induce clinical manifestations [1,3]. Although in our patient tamoxifen therapy could also increase serum calcium levels, we suggest that, because of the possibility of a specific and efficient treatment, hypercalcemia must be investigated in patients with HCC and acute encephalopathy, especially when a rapid response to conventional therapy is not achieved.…”

Section: Discussionmentioning

confidence: 76%

Hypercalcemic Encephalopathy in a Patient with Hepatocellular Carcinoma

et al. 2007

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Cirrhotic patients with hepatocellular carcinoma (HCC) frequently develop hepatic encephalopathy. Metabolic etiology of encephalopathy is less often considered in these patients. Although paraneoplastic hypercalcemia may be associated with several malignant tumors, it has also been described in HCC [1-4], and may cause neurologic disturbances. We present a case of hypercalcemic encephalopathy in a patient with hepatic cirrhosis and underlying HCC in whom first diagnostic was hepatic encephalopathy.

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Section: Discussionmentioning

confidence: 76%

Hypercalcemic Encephalopathy in a Patient with Hepatocellular Carcinoma

et al. 2007

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“…Reports of HCC patients with paraneoplastic syndrome are not uncommon [1, 2, 3, 4, 5, 6]. Four paraneoplastic syndromes have been reported in a single patient [1].…”

Section: Discussionmentioning

confidence: 99%

“…Hepatocellular carcinoma (HCC) sometimes manifests with a variety of paraneoplastic syndrome, such as hypoglycemia [1, 2], erythrocytosis [1, 3], hypercalcemia [1, 4, 5], hypercholesterolemia [1], and thrombocytopenia [6]. Although the reported frequency of paraneoplastic syndrome varies from 1 to 40%, most HCC patients with paraneoplastic syndrome have massive tumors and increased levels of α-fetoprotein (AFP) [1, 2, 3, 6].…”

Section: Introductionmentioning

confidence: 99%

Successful Treatment in a Case of Massive Hepatocellular Carcinoma with Paraneoplastic Syndrome

Tsuchiya¹,

Kubota²,

Takizawa³

et al. 2009

Case Rep Gastroenterol

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Paraneoplastic syndromes of hepatocellular carcinoma (HCC) are not uncommon. However, the prognosis is poor and follow-up and improvement of paraneoplastic syndromes with treatment have been reported rarely. We report a successful case in an aged man of a massive HCC with paraneoplastic syndrome, treated by combined intraarterial chemotherapy and hepatic resection. Paraneoplastic syndrome (erythrocytosis and hyperlipidemia) was monitored throughout the treatment and erythropoietin (EPO) mRNA also was analyzed in the resected liver. The hemoglobin level and serum levels of EPO and total cholesterol (T-cho) decreased dramatically with treatment, along with a decrease in serum levels of α-fetoprotein and protein induced by vitamin vitamin K absence II (PIVKA-II). Semiquantitative reverse transcription polymerase chain reaction (RT-PCR) revealed that the residual cancer expressed EPO RNA but the nontumor tissue did not. This was a rare case of paraneoplastic syndrome of HCC that was treated successfully. This case indicates that paraneoplastic syndrome reflected tumor progression and that serum levels of both EPO and T-cho might be used as tumor markers.

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“…A lterations in parathyroid hormone-related protein (PTHrP) expression are well documented in patients with hypercalcemia of malignancy. [1][2][3] Soon after the cloning of PTHrP in the late 1980s, the homology between the first eight N-terminal amino acids of parathyroid hormone (PTH) and PTHrP was recognized. 4,5 Since then, a substantial amount of work has been conducted on the role of PTHrP in calcium metabolism and function.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid hormone–related protein expression is correlated with clinical course in patients with glial tumors

Pardo

Lien

Fox

et al. 2004

Cancer

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BACKGROUNDParathyroid hormone–related protein (PTHrP) expression modulates cell survival in a number of human solid tumors. Although PTHrP is expressed in normal developing and neoplastic central nervous system tissue, clinical data indicating the importance of this protein with respect to local control and/or survival in patients with glial tumors are scarce.METHODSUsing a standard immunoperoxidase technique, the authors examined PTHrP expression in a population of 51 patients with Daumas–Duport Grade II–IV astrocytomas over a 15‐year period. Both local control and survival were calculated from the date of definitive irradiation to the last time of known follow‐up examination using the actuarial method. PTHrP expression was scored on examination under 40× magnification, with the incidence of cellular staining averaged over 10 high‐power fields. The intensity and extent of staining were characterized semiquantitatively using the standard World Health Organization classification criteria. The median follow‐up duration was approximately 5.5 years. Multivariate analyses were performed to ascertain the statistical significance of several standard clinicohistopatholgic factors (Karnofsky functional status, age, gender, extent of surgical resection, radiotherapy dose, grade, and PTHrP expression) with respect to local control and survival. P < 0.05 was considered indicative of statistical significance.RESULTSPatients with high levels of PTHrP expression had significantly lower glial tumor local control rates and corresponding decreases in progression‐free and overall actuarial survival after definitive irradiation (P < 0.01). In a Cox 3‐variable model, the PTHrP staining score was independent of tumor grade or Karnofsky functional status. It is notable that the strongest predictor of survival was tumor grade (P < 0.001).CONCLUSIONSPTHrP may be an important adjunct to standard immunopathologic criteria in the determination of glial tumor responses. A number of mechanisms were explored to derive a more mechanistic understanding of these translational results. Subsequent prospective studies involving larger patient populations will be necessary before findings can be translated to clinical practice. Cancer 2004. © 2004 American Cancer Society.

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Severe Hypercalcemia as an Initial Presenting Manifestation of Hepatocellular Carcinoma

Cited by 19 publications

References 15 publications

Hypercalcemic Encephalopathy in a Patient with Hepatocellular Carcinoma

Hypercalcemic Encephalopathy in a Patient with Hepatocellular Carcinoma

Successful Treatment in a Case of Massive Hepatocellular Carcinoma with Paraneoplastic Syndrome

Parathyroid hormone–related protein expression is correlated with clinical course in patients with glial tumors

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