Complete Tumor Resection for a Hepatocellular Carcinoma Secreting Parathyroid Hormone-related Peptide

Eun Kyoung Kim; Jin Su Kim; Ki Chul Shin; Gil Tae Lee; Chul Ju Han; Sang Beom Kim; Yun Hyi Ku

doi:10.4166/kjg.2015.66.2.122

Journal List > Korean J Gastroenterol > v.66(2) > 1007409

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Kim, Kim, Shin, Lee, Han, Kim, and Ku: Complete Tumor Resection for a Hepatocellular Carcinoma Secreting Parathyroid Hormone-related Peptide

Case Report

Korean J Gastroenterol 2015;66(2):122-126.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.2.122

Complete Tumor Resection for a Hepatocellular Carcinoma Secreting Parathyroid Hormone-related Peptide

Eun Kyoung Kim, Jin Su Kim, Ki Chul Shin, Gil Tae Lee, Chul Ju Han, Sang Beom Kim¹, Yun Hyi Ku

Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

¹Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea

Correspondence to: Yun Hyi Ku, Department of Internal Medicine, Korea Cancer Center Hospital, 75 Nowon-gil, Nowon-gu, Seoul 01812, Korea. Tel: +82-2-970-1211, Fax: +82-2-970-2438, E-mail: yhkumd@gmail.com

Received 17 January 2015 Revised 23 March 2015 Accepted 26 March 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Hepatocellular carcinoma (HCC) is the fifth most common cancer in Korea. Diverse paraneoplastic syndromes can occur in patients with HCC, but parathyroid hormone-related peptide (PTH-rP)-induced hypercalcemia is uncommon. Hypercalcemia due to PTH or particularly PTH-rP-secreting HCC is associated with poor outcomes. We report a 71-year-old man who presented with symptoms of vague abdominal discomfort, somnolence, lethargy, nausea, vomiting, and weight loss. Imaging studies revealed a large HCC without metastasis. The laboratory findings showed elevated serum calcium level, low intact parathyroid hormone (iPTH) level and elevated PTH-rP level. These results led to a diagnosis of a PTH-rP-secreting HCC and paraneoplastic hypercalcemia. After emergency management of the hypercalcemia, the patient underwent an extended right hemihepatectomy with cholecystectomy. One year after the surgery, he is alive with normal calcium, PTH-rP, and iPTH levels. This case demonstrates that the rare phenomenon of life-threatening hypercalcemia caused by HCC should not be overlooked. These symptoms offer a good opportunity to diagnose HCC early. Radical tumor resection makes it possible to cure patients with PTH-rP-secreting HCC.

Keywords: Hepatocellular carcinoma, Parathyroid hormone-related protein, Paraneoplastic syndromes

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Fig. 1.

Hepatocellular carcinoma at the time of diagnosis. A 13-cm tumor is visualized in the right hepatic lobe.

Fig. 2.

Immunohistochemistry of the tumor specimen. (A) Microscopically tumor cells show trabecular growth patterns separated by sinusoids (H&E, ×400). (B) Positive staining for glypican-3 (×400). (C) Negative staining for CK19 (×400). (D) Negative staining for parathyroid hormone (×400).

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