J Korean Endocr Soc.  2008 Jun;23(3):204-209. 10.3803/jkes.2008.23.3.204.

Two Cases of Primary Hyperparathyroidism Associated with Colon Cancer

• Chun SH
• Kim YK
• Yun JS
• Jang EH
• Park SA
• Cho JH
• Ko SH
• Ahn YB
• Suh YJ
• Kim JG

• KMID: 1479208
• DOI: http://doi.org/10.3803/jkes.2008.23.3.204

Abstract

Hypercalcemia is often observed in cancer patients secondary to parathyroid hormone (PTH) related peptide production. However, primary hyperparathyroidism and colon cancer rarely present simultaneously. Calcium is believed to have a chemopreventive effect against colorectal cancer because it reduces crypt cell hyperproliferation in both humans and in animals. There is evidence to suggest that the incidence of colorectal cancer in humans is reduced by high calcium intake. In patients with primary hyperparathyroidism, increased PTH activates 1,25(OH)2D and enhances calcium absorption in the gut. Consequently, the calcium level in the lumen is decreased, leading to an elevated risk of colorectal cancer. We report two patients with colon cancer and hypercalcemia secondary to primary hyperparathyroidism, along with a brief review of the literature.

Keyword

colonic neoplasms; hypercalcemia; hyperparathyroidism

MeSH Terms

Absorption
Animals
Calcium
Colon
Colonic Neoplasms
Colorectal Neoplasms
Humans
Hypercalcemia
Hyperparathyroidism
Hyperparathyroidism, Primary
Incidence
Parathyroid Hormone
Calcium
Parathyroid Hormone

Figure

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  Fig. 1 1-1. Thyroid sonography finding showed 1.3 × 0.85 cm sized heterogenous low echogenic mass in the lower pole of right thyroid lobe. 1-2. 99mTc-sestamibi scan showed no increased abnormal radioactivity in (A) early image (10 minutes), however, there was a hot uptake in the lower pole of right thyroid bed suggested parathyroid adenoma in (B) delayed image (2 hours, in black arrow).

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  Fig. 2 Abdominal CT showing about 1.8 cm sized well enhancing mass was noted in the right adrenal gland(black arrow).

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  Fig. 3 (A) Well differentiated adenocarcinoma of colon is seen, in which the glands are much larger and have irregular shape (×200, H&E stain). (B) Histologic finding of removed parathyroid gland showed encapsulated, cellular, homogenous lesions composed of chief cells with some oxyphil cells in a delicate capillary network (×200, H&E stain).

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  Fig. 4 4-1. Thyroid sonography showed 1cm sized oval shape nodule in right upper lobe. 4-2. 99mTc-Sestamibi scan showed no increased abnormal radioactivity in early image (10 minutes) (A). But there was a focal delayed washout of radiotracer is noted in lower portion of right thyroid bed (2 hours, in black arrow) (B).

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  Fig. 5 Microscopically, a moderately differentiated adenocarcinoma of colon is seen here. There is a glandular configuration, but the glands are irregular and crowded (×200, H&E stain).

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