Adenosquamous carcinoma of the pancreas associated with humoral hypercalcemia of malignancy (HHM)

J Hepatobiliary Pancreat Surg. 2008;15(5):531-5. doi: 10.1007/s00534-007-1258-x. Epub 2008 Oct 4.

Abstract

We report a rare case of adenosquamous carcinoma of the pancreas associated with humoral hypercalcemia of malignancy (HHM) in which parathyroid hormone-related protein (PTH-rP) was identified as the causative factor of hypercalcemia. A 72-year-old Japanese man was admitted to our institution complaining of fever and abdominal pain. Abdominal computed tomography demonstrated a large tumor in the body of the pancreas, with multiple liver metastases. Both serum calcium and PTH-rP levels were elevated. No accumulation was observed on bone scan with technetium-99. The patient died of pneumonia 3 months after admission. Autopsy demonstrated that the neoplasm in the pancreas showed an abrupt histological transition from adenocarcinoma to squamous cell carcinoma. PTH-rP was identified in the primary pancreatic tumor cells by immunohistochemical examination and a reverse-transcription polymerase chain reaction (RTPCR) method. We concluded that PTH-rP was the causative factor of the HHM, based on the laboratory data, immunohistochemical examination, and messenger RNA (mRNA) expression. This is a very rare report of adenosquamous cell carcinoma of the pancreas associated with HHM.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carcinoma, Adenosquamous / blood
  • Carcinoma, Adenosquamous / complications*
  • Humans
  • Hypercalcemia / etiology*
  • Male
  • Pancreatic Neoplasms / blood
  • Pancreatic Neoplasms / complications*
  • Paraneoplastic Syndromes / blood
  • Paraneoplastic Syndromes / etiology
  • Parathyroid Hormone-Related Protein / analysis

Substances

  • Parathyroid Hormone-Related Protein