ABSTRACT
INTRODUCTION: In urothelial cancer, several paraneoplastic syndromes can be triggered by the aberrant expression of hormones, growth factors or lymphokines by tumor cells. CASE PRESENTATION: A 71-year-old female patient underwent radical cystectomy for muscle-invasive urothelial cancer. Shortly after the operation, the patient presented with a leukemoid reaction and hypercalcemia. Computed tomography scans revealed a rapidly progressing tumor on the left pelvic side, and serum levels of granulocyte-colony stimulating factor, parathyroid hormone-related protein, and beta human chorionic gonadotropin were elevated. The patient also tested positive for serum squamous cell carcinoma antigen. Hypercalcemia was successfully treated with denosumab. However, the patient's leukocyte counts steadily increased, her condition deteriorated and she passed away. CONCLUSION: To the best of our knowledge, this is the first report of urothelial cancer that tested positive for four tumor markers. The findings support the idea that poorly differentiated bladder carcinomas can ectopically secrete multiple proteins causing pleiotropic paraneoplastic syndromes.
ABSTRACT
A 57-year-old man presented with abdominal discomfort. A computed tomography (CT) scan revealed a tumor, with a maximum diameter of approximately 5 cm, in the transverse mesocolon near the splenic flexure as well as a small nodular shadow suggestive of peritoneal dissemination on the greater omentum. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) showed marked accumulations of FDG at the same sites. Laparoscopic examination revealed an elastic hard tumor, with a maximum diameter of slightly over 5 cm, at the posterior sheath of the transverse mesocolon and a small nodule on the greater omentum with apparent dissemination. Since radical surgery was considered to be difficult to perform, we only resected the disseminated nodule for diagnostic purposes. The final pathological diagnosis was biphasic- type (mixed epithelial and sarcomatoid type) malignant mesothelioma arising from the peritoneum. Approximately 20 days postoperatively, the patient received combination therapy with pemetrexed and cisplatin with a 3-week interval between the courses. Image assessment after completion of the third course revealed enlargement of the tumor mass and worsening of the peritoneal dissemination. Therefore, the treatment was switched to paclitaxel, which has been reported to be effective as a second-line therapy. The drug was scheduled to be administered on days 1, 8, and 15. However, after the first course on day 1, the patient's condition gradually deteriorated and he subsequently died.
