A Case Report of Esophageal Carcinoma That Produced Parathyroid Hormone Related Protein (PTHrP) and G-CSF and Manifested Hypercalcemia and Leukocytosis

Tatsuya Okimoto, Hiroshi Yahata, Keizou Sugino, Tohru Takiguchi, Kentarou Emoto, Katsunori Shinozaki, Hidehiro Tanji, Tsuyoshi Kataoka, Fumio Shimamoto^* and Toshimasa Aashara

Second Department of Surgery, Faculty of Medicine, Hiroshima University, Department of Pathology, Hiroshima University Hospital^*

We report a case of esophageal carcinoma that manifested hypercalcemia and leukocytosis with the production of parathyroid hormone related protein (PTHrP) and G-CSF. A 72-year-old man had a type 2 tumor from Ut to Mt 6 cm in diameter. Blood cell count on admission showed leukocytosis (WBC 12,100/mm³) but calcium was within normal limits (Ca⁺⁺7.4c 1.21mmol/l). Staging by imaging study was T3N2M0Stage III. Subtotal esophagectomy was conducted on June 10,1999. WBC count became normal after surgery. Hypercalcemia appeared on POD 69 accompanied by re-elevated WBC count. Parathyroid related protein in blood was 306 pmol/l and supernatant of cloned culture esophagus carcinoma was 272 pmol/l. Further immunohistochemical study showed positive staining of PTHrP and G-CSF in tumor cells. This is the first case, to our knowledge, in which simultaneous production of PTHrP and G-CSF was proved directly from esophageal squamous cell carcinoma cells.

Key words
parathyroid hormone related protein, granulocyte-colony stimulating factor, squamous cell carcinoma of esophagus

Reprint requests
Tatsuya Okimoto Second Department of Surgery. Faculty of Medicine, Hiroshima University 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JAPAN

Accepted
September 19, 2001

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