Parathyroid hormone‐related peptide producing cholangiocellular carcinoma with a marked psammoma formation

Abstract

Humoral hypercalcemia caused by parathyroid hormone-related peptide (PTHrP), associated with cholangiocellular carcinoma (CCC), has rarely been documented. There have been no reports of CCC associated with extensive calcification of the tumor with psammoma body formation. A 66-year-old man was admitted with a large calcified tumor in the liver detected on an abdominal X-ray. An ultrasound-guided fine needle biopsy specimen of the liver tumor showed evidence of adenocarcinoma. He had hypercalcemia with an elevated PTHrP level. The patient died because of disseminated intravascular coagulation and progressive hepatic failure. A postmortem examination revealed a large poorly differentiated CCC in the liver. Immunohistochemical examination showed the presence of PTHrP-positive tumor cells. The calcified lesion consisted of a number of accumulated psammoma bodies. We present a case of PTHrP producing CCC with a marked psammoma formation.

Cholangiocarcinoma Producing Parathyroid Hormone-related Peptide Treated with Chemoradiation Using Gemcitabine and S-1

“…Although chemotherapy for CCC is administered to those patients who are not operable, the results are largely disappointing (3), especially for CCC producing PTHrP (Table 1) (2,(4)(5)(6)(7).…”

Psammoma body and its precursors in papillary thyroid carcinoma: A study by fine‐needle aspiration cytology

“…1 They also have been described in lactotrope adenoma of the pituitary, 2 cholangiocellular carcinoma, 3 chromophobe renal cell carcinoma, 4 and meningioangiomatosis. 5 In PTC, PBs are found within the cores of papillae or in tumor stroma but usually not in neoplastic follicles.…”

Psammoma body: A product of dystrophic calcification or of a biologically active process that aims at limiting the growth and spread of tumor?

“…Meningiomas (45%) 6 and one-third of serous cystadenocarcinomas of ovary 7 also show PBs. PBs have been reported rarely in other neoplasms, viz, insulinoma, 8 lactotrope adenoma of pituitary, 9 serous papillary adenoma of borderline malignancy of the broad ligament, 10 uterine serous carcinoma, 11 endocervical adenocarcinoma, 12 cholangiocellular carcinoma, 13 chromophobe renal cell carcinoma, 14 psammoma carcinoma of the peritoneum, 15 and a number of benign non-neoplastic conditions including colloid goiter and Hashimoto's thyroiditis. [16][17][18][19][20][21][22] In a study by Khoo et al, 23 29 (59.2%) of the 49 patients with ultrasonographic (US) evidence of intrathyroidal calcifications, had PTC and 12 of the remaining 20 cases had MNG in histology.…”