Humoral hypercalcemia of malignancy(HHM)を伴った腎盂扁平上皮癌の1例

Abstract

78歳男.食欲不振に続いて意識障害が出現し近医受診した.腹部CTで右腎に腫瘤を認められ当科に紹介された.血液検査でカルシウムと副甲状腺ホルモン(PTH)関連ペプチドの高値およびPTHの低値を認めた.高カルシウム血症に対してアレンドロン酸ナトリウム水和物を投与し, 血中カルシウム値は正常化, 症状も改善した.右腎の腫瘤に対しては単純摘出術を行い, 摘出標本の病理組織学的所見および免疫染色所見からPTH関連ペプチド産生腎盂扁平上皮癌と診断した

A 78-year-old male was urgently admitted to our hospital because of consciousness disturbance. Laboratory data showed marked hypercalcemia (17.0 mg/dl), hypophosphatemia, low intact PTH level, high PTH relating peptide (PTHrP) level, normal osteocalcin and normal 1-25(OH)2D level. Computed tomography revealed a right renal tumor with extracapsular extension. Bone scintigram appeared normal. We performed right nephrectomy under the diagnosis of right renal tumor. Pathological diagnosis was poorly differentiated squamous cell carcinoma (SCC) of the right pelvis. Immunohistochemical study of the resected specimen for PTHrP was positive. Therefore, we diagnosed it as renal pelvic SCC with humoral hypercalcemia of malignancy (HHM). After nephrectomy, serum calcium returned to normal, but 5 months after nephrectomy, local recurrence appeared and serum calcium was re-elevated. She died 7 months after nephrectomy.