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Hypercalcemia Associated with Extramammary Paget's Disease.
Tetsuko Sato1, Yoshihisa Wada2, Nobuhiko Kamitani3
1Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan.
Case Reports in Oncology
|November 11, 2020
Summary
Humoral hypercalcemia of malignancy, often caused by parathyroid hormone-related protein (PTHrP), can occur in advanced cancers. Early measurement of serum calcium and PTHrP is crucial for patients with extramammary Paget's disease presenting with altered consciousness.
Area of Science:
- Oncology
- Endocrinology
- Pathology
Background:
- Hypercalcemia of malignancy affects up to one-third of advanced cancer patients.
- Humoral hypercalcemia of malignancy, driven by parathyroid hormone-related protein (PTHrP), is the most common cause.
- Extramammary Paget's disease is a rare cutaneous malignancy that can metastasize.
Observation:
- A 70-year-old male with metastatic extramammary Paget's disease presented with altered consciousness and a genital tumor.
- Elevated serum calcium (15.3 mg/dL) and intact PTHrP (66.1 pg/L) levels were confirmed.
- PTHrP immunohistochemistry was positive in tumor cells, confirming humoral hypercalcemia of malignancy.
Findings:
- Standard treatments for hypercalcemia provided only temporary relief.
- The patient experienced rapid enlargement of liver metastases and general condition deterioration.
- The patient died on day 55, highlighting the aggressive nature of the metastatic disease.
Implications:
- Early detection of hypercalcemia and PTHrP-producing tumors is critical in extramammary Paget's disease patients with altered consciousness.
- This case underscores the challenges in managing hypercalcemia of malignancy in advanced extramammary Paget's disease.
- Further research into novel therapeutic strategies for managing hypercalcemia in rare metastatic cancers is warranted.
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