Severe malignancy‐associated hypercalcemia in dysgerminoma

Abstract

Hypercalcemia is a rare complication of pediatric malignant germ cell tumors. The problem may be missed because of unawareness among pediatric oncologists. We describe a 16-year-old girl with an ovarian dysgerminoma associated with severe hypercalcemia, a metabolic abnormality infrequently reported with this disease. We review some of the potential causes of malignancy-associated hypercalcemia and current treatment strategies. It is our recommendation that calcium levels should be monitored in all children with solid ovarian masses. Hypercalcemia seen in these situations may not improve until the tumor is removed.

Diagnóstico de disgerminoma ovariano durante a gestação

“…Since the patient described here was pregnant and had no phenotypical signs that would suggest relevant syndromic data, she was not asked about, or assessed for, this possibility. An association between dysgerminoma and malignant hypercalcemia 10,18,19 has been described by some authors, but in this case tests showed that the patient was within normal limits. Another peculiarity that attracts attention is the association with dysgerminoma described in some varieties of animals 20,21 .…”

Excision of extensive metastatic dysgerminoma to control refractory hypercalcaemia in a child at high risk for tumour-lysis syndrome

“…In this case, however, the need to control serum calcium and deal with the acute renal failure prompted careful reconsideration of leading with chemotherapy. First, there was concern that chemotherapy might be ineffective given reports suggesting tumour excision can be necessary (and rarely still not sufficient) for hypercalcaemia control [2,12]. Second, and perhaps most importantly, the anti-tumour effects of chemotherapy and its side effects are non-trivial in the context of a child in hypercalcaemic renal failure.…”

“…Previous reports have described removal of isolated ovarian dysgerminomas to control malignant hypercalcaemia in children [2,3]. Rare cases of hypercalcaemia in adults with metastatic dysgerminoma have been managed in a variety ways, ranging from abdominal radiotherapy or chemotherapy to bilateral oophorectomy, with or without hysterectomy [5][6][7][8].…”

“…In children with solid tumours, malignant hypercalaemia is rarer still and may be highly resistant to medical treatment (resolving only once the tumour is excised) [2]. Dysgerminomas are classic examples where excision of isolated ovarian lesions has promptly controlled associated hypercalcaemia [2,3]. In children with huge ovarian primaries judged unsuitable for primary excision, chemotherapy and even tumour chemoembolisation have been tried instead for calcium control [4].…”

“…Most cases are associated with haematological malignancies and are treated medically. In children with solid tumours, malignant hypercalaemia is rarer still and may be highly resistant to medical treatment (resolving only once the tumour is excised) [2]. Dysgerminomas are classic examples where excision of isolated ovarian lesions has promptly controlled associated hypercalcaemia [2,3].…”