Hypercalcemia with concomitant elevation of serum parathyroid hormone (PTH) and PTH-related protein (PTHrP) levels was found in a patient with advanced gastric carcinoma and multiple liver metastases. The most common features are hypercalcemia associated with hypersecretion of PTHrP and physiological suppression of PTH secretion in the syndrome of humoral hypercalcemia of malignancy (HHM). Although we initially made a diagnosis of primary hyperparathyroidism concomitant with HHM due to gastric cancer, diagnostic imaging studies, such as echography, CT, sestamibi scintigraphy, and autopsy findings, did not reveal evidence of any parathyroid tumors or ectopic parathyroid glands in the mediastinum. Both primary and metastatic tumor cells showed positive staining with PTH-specific antibody as well as PTHrP-specific antibody on immunohistochemical examination. PTH concentration in the cytosolic fraction of the metastatic tumor was elevated compared to that from a control patient with no calcium metabolic disorders in vitro. These findings indicated that PTH secreted ectopically by gastric cancer cells, not by parathyroid glands, caused hypercalcemia in this patient. To our knowledge, this is the first case report of PTH-secreting gastric carcinoma cells. We report the case and a review of the previous reported PTH-secreting non-parathyroid tumors along with the mechanisms of secretion.

译文

:患有晚期胃癌和多发肝转移的患者发现高钙血症并伴有血清甲状旁腺激素(PTH)和PTH相关蛋白(PTHrP)升高。在恶性体液性高钙血症(HHM)综合征中,最常见的特征是与PTHrP过度分泌相关的高钙血症和PTH分泌的生理抑制。尽管我们最初诊断出因胃癌而伴有HHM的原发性甲状旁腺功能亢进症,但影像学检查(如回波描记术,CT,司他他比闪烁显像和尸检结果)并未显示出纵隔中有任何甲状旁腺肿瘤或异位甲状旁腺的证据。在免疫组织化学检查中,原发性和转移性肿瘤细胞均显示PTH特异性抗体和PTHrP特异性抗体呈阳性染色。与没有钙代谢异常的对照组患者相比,转移性肿瘤的胞质部分中的PTH浓度升高。这些发现表明,胃癌细胞而不是甲状旁腺分泌的异位PTH引起该患者高钙血症。据我们所知,这是分泌PTH的胃癌细胞的首例报道。我们报告该病例,并对先前报道的分泌PTH的非甲状旁腺肿瘤及其分泌机制进行了回顾。

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