Korean J Gastroenterol.  2015 Jun;65(6):361-365. 10.4166/kjg.2015.65.6.361.

Esophageal Cancer Initially Presenting as Severe Paraneoplastic Hypercalcemia Requiring Hemodialysis

• Ahn HS
• Yun JM
• Lee YB
• Ko YM
• Lee JE
• Won HS
• Kim SS
• Kim YO

• KMID: 2373238
• DOI: http://doi.org/10.4166/kjg.2015.65.6.361

Abstract

Paraneoplastic hypercalcemia without bone metastasis occurs rarely in esophageal cancer. A 75-year-old man was admitted for general weakness and lethargy. Laboratory data showed high serum calcium level (corrected calcium 14.6 mg/dL), low parathyroid hormone level (3.3 pg/mL) and high parathyroid hormone-related peptide level (3.5 pmol/L). Esophagogastroscopy showed a malignant tumor in the esophagus. Histology showed moderately differentiated squamous cell carcinoma. Bone scan showed no evidence of bone metastasis. Since the patient's calcium levels remained high and mental state did not show improvement despite intravenous fluid therapy, diuretics and intravenous bisphosphonate, hemodialysis was started. After hemodialysis treatment, the serum calcium level subsequently normalized and his mental status improved. Herein, we report a rare case of paraneoplastic hypercalcemia in a patient with esophageal cancer.

Keyword

Hypercalcemia; Esophageal neoplasms; Hemodialysis

MeSH Terms

Aged
Calcium/blood
Carcinoma, Squamous Cell/*diagnosis/pathology
Endoscopy, Digestive System
Esophageal Neoplasms/*diagnosis/pathology
Humans
Hypercalcemia/*diagnosis/pathology
Male
Parathyroid Hormone-Related Protein/blood
Renal Dialysis
Severity of Illness Index
Tomography, X-Ray Computed
Calcium
Parathyroid Hormone-Related Protein

Figure

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  Fig. 1. CT scan shows eccentric wall thickening of lower esophagus and paratracheal node enlargement.

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  Fig. 2. Esophagogastroscopy shows an ulcerative mass with bleeding and necrosis on the distal esophagus.

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  Fig. 3. Histologic findings shows moderately differentiated squamous cell carcinoma (H&E stain, ×100).

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  Fig. 4. Bone scan shows no evidence of bone metastasis.

Reference

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