Abstract
We present herein the case of a 60-year-old man found to have a rare type of cloacogenic anal carcinoma. The disease was advanced and aggressive with local invasion to the prostate as well as distant lymph node metastases to the neck and paraaortic region on presentation. Therefore, a palliative abdominoperineal resection was performed, 10 weeks following which the patient developed humoral hypercalcemia. Despite treatment with hydration, furosemide, steroids, and calcitonin, serum calcium continued to rise and the patient died on the 95th postoperative day. Laboratory findings revealed a decreased parathyroid hormone (PTH) level and marked elevation of parathyroid hormone-related protein (PTHRP). The detection of the PTHRP in the tumor extract and the positive immunohistochemical staining for this in the tumor cells suggested that the humoral hypercalcemia was definitely caused by its associated tumor production. Although hypercalcemia is not an uncommon complication of solid cancers in their late stage, only three other cases of rectal cancer with hypercalcemia have ever been reported. To our knowledge, this is the first documentation of cloacogenic anal carcinoma accompanied by PTHRP-induced severe humoral hypercalcemia.
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References
Mundy GR, Martin TJ (1982) The hypercalcemia of malignancy: pathogenesis and management. Metabolism 32:1247–1277
Monno S, Nagata A, Furuta S (1987) Hypercalcemia of cancer in the digestive tract. J Clin Gastroenterol 9(1):78–82
Mann NS, Sachdev AJ (1977) Carcinoma of the esophagus and hypercalcemia. Am J Gastroenterol 67:135–140
Kubota H, Koyama Y, Hojo K, Shimamura Y, Onishi T, Tanaka M, Abe K, Itabashi M, Hirota T (1980) Adenosquamous cell carcinoma of the colon with severe hypercalcemia: Report of two cases. Jpn J Oncol 10:311–320
March R, Ulin R, Puccio C, Savino J, Arlin Z, Ahmed T, Mittelman A (1991) Hypercalcemia associated with adenocarcinoma of the rectum. A case report and review of the literature. Anticancer Res 11:2029–2030
Palvio DHB, Sorensen FB, Klove-Mogensen M (1985) Stem cell carcinoma of the colon and rectum. Report of two cases and review of the literature. Dis Colon Rectum 28:440–445
Mundy GR, Ibbotson KJ, D'Souza SM, Simpson EL, Jacobs JW, Martin TJ (1984) Hypercalcemia of cancer: clinical implications and pathogenic mechanisms. N Engl J Med 310:1718–1727
Burtis WJ, Brady TG, Orloff JJ, Ersbak JB, Warrell RP, Olson BR, Wu TL, Mitnick ME, Broadus AE, Stewart AF (1990) Immunochemical characterization of circulating parathyroid hormone related protein in patients with hymoral hypercalcemia of cancer. N Engl J Med 322:1106–1112
Chevinsky AH, Berelowitz M, Hoover HC Jr (1987) Adenosquamous carcinoma of the colon presenting with hypercalcemia. Cancer 60:1111–1116
Berkelhammer CH, Baker AL, Block GE, Bostwick DG, Michelassi F (1989) Humoral hypercalcemia complicating adenosquamous carcinoma of the proximal colon. Dig Dis Sci 34:142–147
Khan M, Barron J (1982) Cloacogenic carcinoma: A study of six cases and review of the literature, Am J Gastroenterol 77:137–140
Levin SE, Cooperman H, Freilich M, Lomas M, kaplan L (1977) Transitional cloacogenic carcinoma of the anus. Dis Colon Rectum 20:17–23
Schlienger M, Krzisch C, Pene F, Marin JL, Gindre-Vie B, Mauban S, Barthelemy N, Habrand JL, Socie G, Parc R, Gallot D, Malafosse M, Laugier A (1989) Epidermoid carcinoma of the anal canal. Treatment results and prognostic variables in a series of 242 cases. Int J Radiat Oncol Biol Phys 17:1141–1151
Frost DB, Richards PC, Montague ED, Giacco GG, Martin RG (1984) Epidermoid cancer of the anorectum. Cancer 53:1285–1293
Goldman S, Glimelius B, Pahlman L, Stahle E, Wilander E (1988) Anal epidermoid carcinoma: a population-based clinicopathological study of 164 patients. Int J Colorect Dis 3:109–118
Boman BM, Moertel CG, O'Connell JH, Scott M, Weiland LH, Beart RW, Gunderson LL, Spencer RJ (1984) Carcinoma of the anal canal: a clinical and pathological study of 188 cases. Cancer 54:114–125
Kramer S, Reynolds FH, Castillo M, Yalenzwela DM, Thorikay M, Sorvillo JM (1990) Immunological identification and distribution of parathyroid hormone-like protein polypeptides in normal and malignant tissues. Endocrinology 128:1927–1937
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Nobusawa, S., Sato, S., Matsumoto, A. et al. Cloacogenic anal carcinoma presenting with humoral hypercalcemia: Report of a case. Surg Today 25, 970–973 (1995). https://doi.org/10.1007/BF00312384
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DOI: https://doi.org/10.1007/BF00312384