Anaplastic Thyroid Carcinoma with Humoral Hypercalcemia of Malignancy (HHM): An Autopsy Case Report

Abstract

Abstract. An 84-year-old woman was admitted to our hospital for the examination and treatment of painful right thyroid swelling on August 2, 2002. Thyroid ultrasonography showed a mass of about 6 cm in diameter at the right thyroid lobe. Aspiration biopsy cytology (ABC) of her mass showed a thyroid carcinoma. Her neck mass was cold on 123 I scintigraphy and hot on both early-and delayed-phase 201 Tl scintigraphy. Whole body 67 Ga scintigraphy scan showed a strong hot accumulation in the area from the right thyroid lobe to the right lateral lobe. Multiple lung tumors were observed from chest computed tomography (CT) scans. She was diagnosed as having an anaplastic thyroid carcinoma with metastatic lung tumors. As her thyroid carcinoma was inoperable, percutaneous injection therapy of lipiodol and ethanol (lip-PEIT) against the primary thyroid carcinoma was performed twice a week. However, the thyroid carcinoma gradually enlarged and oppressed her trachea. Two months after the initiation of lip-PEIT, parathyroid hormone-related protein (PTHrP)-dependent hypercalcemia was diagnosed because serum levels of calcium, phosphate and intact-PTHrP were 2.72 mmol/l (10.9 mg/dl), 0.71 mmol/l (2.2 mg/dl), 3.2 pmol/l, respectively. The hypercalcemia was reduced by the use of pamidronate. After one week she died of an airway obstruction caused by the developing thyroid carcinoma. Carcinoma cells with a mixed papillary and squamoid pattern were positively stained immunohistochemically by anti-PTHrP(1-34) antisera. Herein, we report a rare autopsy case of a PTHrP-producing thyroid carcinoma.

Anaplastic Thyroid Carcinoma Associated with Graves' Disease

“…The reported risk factors for ATC are age, gender, acute symptoms, larger tumor size, distant metastasis, and leukocytosis [15], which are important but not quite enough to establish suspicion of ATC at an early stage. Although there have been some case reports showing ATC producing granulocyte colony-stimulating factor (G-CSF) or parathyroid hormone-related protein (PTH-rp) [14,45], neither higher G-CSF nor higher PTH-rp was found in our study. It is widely believed that multiple incidents of damage to the genome including p53 mutations lead to anaplastic transformation of differentiated thyroid cancer [14], but, unfortunate-ly, genetic testing cannot be performed with ease and was not done in our study.…”

American Thyroid Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer

“…Free thyroxine and thyrotropin should be assessed because large tumor masses may have compromised thyroid function, and some cases of ATC are associated with significant thyrotoxicosis (89,90). Calcium and phosphorus should be measured because tumor invasion may compromise parathyroid function, and unusual ATC cases can present with humoral hypercalcemia of malignancy (91). Since ATC is most common in elderly patients, often with diminished nutrition, ionized calcium provides superior assessment of calcium status (92), although calculations involving serum protein levels and total calcium values may be useful when ionized calcium values are not available (93).…”

Primary Squamous Cell Carcinoma of the Thyroid: Report of Three Cases

“…Rarely do patients present with leukocytosis and hypercalcemia [20]. Parathyroid hormone-related peptides produced by SCC are believed to be responsible for hypercalcemia [21]. None of our patients presented with these systemic features, but had classical symptoms.…”