Hypercalcemia an exceptional complication in upper urinary tract urothelial carcinoma

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Abstract

Tumors of the upper urinary tract are discovered, either by clinical symptomatology or as part of the evaluation of a bladder tumor. Hypercalcemia is one of the most common paraneoplastic syndromes and an exceptional complication of urothelial carcinoma of the upper tract. Several physiopathological mechanisms have been proposed to explain this rare and serious complication. Hypercalcemia is often correlated with tumors with a poor prognosis.

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Most cited references 4

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Hypercalcemia in Upper Urinary Tract Urothelial Carcinoma: A Case Report and Literature Review

Keiko Asao, Jonathan B. McHugh, David C Miller … (2013)

Objective. We here report a patient with upper urinary tract urothelial carcinoma with hypercalcemia likely due to elevated 1,25-dihydroxyvitamin D. Methods. We present a clinical case and a summary of literature search. Results. A 57-year-old man, recently diagnosed with a left renal mass, for which a core biopsy showed renal cell carcinoma, was admitted for hypercalcemia of 11.0 mg/mL He also had five small right lung nodules with a negative bone scan. Both intact parathyroid hormone and parathyroid hormone-related peptide were appropriately low, and 1,25-dihydroxyvitamin D was elevated at 118 pg/dL. The patient's calcium was normalized after hydration, and he underwent radical nephrectomy. On the postoperative day 6, a repeat 1,25-dihydroxyvitamin D was 24 pg/mL with a calcium of 8.1 mg/dL. Pathology showed a 6 cm high-grade urothelial carcinoma with divergent differentiation. We identified a total of 27 previously reported cases with hypercalcemia and upper tract urothelial carcinoma in English. No cases have a documented elevated 1,25-dihydroxyvitamin D level. Conclusion. This clinical course suggests that hypercalcemia in this case is from the patient's tumor, which was likely producing 1,25-dihydroxyvitamin D. Considering the therapeutic implications, hypercalcemia in patients with upper urinary tract urothelial carcinoma should be evaluated with 1,25-dihydroxyvitamin D.

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Resolution of hypercalcemia of malignancy following radical cystectomy in a patient with paraneoplastic syndrome associated with urothelial carcinoma of the bladder

Alfredo la Rosa, Ahmed Ali, Sanjaya Swain … (2015)

Hypercalcemia of malignancy is a common finding associated with different types of cancers; however, its association with urothelial carcinoma of the bladder is rare. We report a case of a 69-year-old male with nonmetastatic urothelial carcinoma of the bladder who developed hypercalcemia that failed to respond to medical management, but resolved completely after undergoing resection of the tumor through radical cystectomy.

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[Imaging of upper urinary tract tumors].

J. Delomez, M Claudon, C Darmaillacq … (2002)

Urothelial tumors of the upper urinary tract are mainly represented by transitional cell carcinomas. They are usually multifocal, synchronous or metachronous. Patients most often present with hematuria. Histological staging is according to the degree of cellular anaplasia (grade) as well as to the degree of wall invasion (stage). Accurate and differential diagnosis are by excretory urography (EU) and/or by computed tomography (CT) associated with EU. EU and endoscopic investigations assess tumoral extension. The most appropriate treatment is radical nephroureterectomy with a cuff of bladder. Early and high recurrence is common; therefore a regular follow-up is required and depends on the initial treatment and the tumoral aggressiveness. This follow-up is performed by imaging, endoscopic and cytologic investigations.

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Author and article information

Contributors

Issam Jandou

Elmehdi Wichou

Adnane Ettanji

Amine Moataz

Dakir Mohammed

Adil Debbagh

Rachid Aboutaieb

Journal

Journal ID (nlm-ta): J Surg Case Rep

Journal ID (iso-abbrev): J Surg Case Rep

Journal ID (publisher-id): jscr

Title: Journal of Surgical Case Reports

Publisher: Oxford University Press

ISSN (Electronic): 2042-8812

Publication date Collection: February 2021

Publication date (Electronic): 08 February 2021

Publication date PMC-release: 08 February 2021

Volume: 2021

Issue: 2

Electronic Location Identifier: rjaa574