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Successful treatment of paraneoplastic hypercalcemia in a patient with giant condyloma acuminatum: a case report
© Linnemann et al.; licensee BioMed Central Ltd. 2013
Received: 26 March 2013
Accepted: 29 August 2013
Published: 7 November 2013
While paraneoplastic syndromes in patients with malignant and metastasizing tumors are common, they are rarely associated with skin tumors showing predominantly local growth patterns. This case report relates to a patient with giant condyloma acuminatum, also called Buschke-Löwenstein tumor, with paraneoplastic hypercalcemia, who was successfully treated with conservative treatment.
The patient in question is a 48-year-old German man with a giant periscrotal tumor. Before and during the therapy, two episodes of symptomatic hypercalcemia occurred, which were successfully treated by bisphosphonates, intravenous fluids and diuretics. No evidence of lytic bone affection was found.
Paraneoplastic hypercalcemia may occur in patients who have a Buschke-Löwenstein tumor. For patients, where surgery is not an option, established medical therapies like bisphosphonates may be useful in addition to diuretics and infusions.
Paraneoplastic syndromes occur commonly and are well-known. They may appear before or during tumor manifestation. Different types involving different tissues, for example dermatological, neuronal or endocrinological paraneoplastic syndromes, are known. An incidence up to 10% of paraneoplastic hypercalcemia is reported in patients with lung cancer. It is also commonly seen in aggressive cancers such as breast cancer or multiple myeloma . Paraneoplastic hypercalcemia may appear without evidence of bone metastases . It is the most common metabolism-disorder that is induced by a tumor-associated peptide-releasing hormone . Meyer-Heim et al. assumed a paraneoplastic prevalence in 40% of hypercalcemia . Buschke-Löwenstein tumors are rare and usually grow slowly. They are thought to be induced by the human papilloma virus (HPV), most commonly type 6 and 11 . Usually, it is associated with extensive local infiltration. Most authors consider it to be a verrucous carcinoma, which rarely metastasizes .
Results of the patient’s calcium metabolism
First stay, first results
First stay, final results
Second stay, first results
Second stay, final results
While paraneoplastic hypercalcemia is well-known for many malignant diseases, it is rarely described in patients with localized skin tumors. In a single center study with 412 patients with cutaneous squamous cell carcinoma (SCC), Nicolae et al. reported a low PTH-independent hypercalcemia prevalence of 1.21% . Furthermore, two cases with hypercalcemia-hyperleukocytosis paraneoplastic syndrome in cutaneous squamous cell carcinoma were described .
As far as it is known, there is only one case report of paraneoplastic hypercalcemia in Buschke-Löweinstein-tumor . Hernandez et al. described a patient with Buschke-Löwenstein-tumor and elevated PTH-related protein (PTH-rp). After surgical treatment, hypercalcemia was normalized and PTH-rp became undetectable. In this patient, surgery finally resolved the problem. In our patient however, primary surgery was not an option due to the size and mass of the tumor. In the case of paraneoplastic syndrome some authors suggest a three point management plan: involving treatment of the primary tumor to eliminate the source of antigens; steroid based-immunosuppression to avoid antigen-antibody reactions; and symptomatic medication with bisphosphonates, diuretics and infusions to lower elevated calcium levels . In this case, the use of steroids was withheld to await the effect of radiotherapy.
Paraneoplastic hypercalcemia may occur in patients with Buschke-Löwenstein tumor. For patients who are not suitable for surgery, established medical therapies like bisphosphonates may be useful in addition to diuretics and infusions.
Written informed consent was obtained from the patient for publishing this case report and any accompanying pictures. A copy of the written informed consent is available for review by the Editor-in-Chief-of this journal.
We thank our patient for agreeing to present his case.
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