2017 Volume 57 Issue 3 Pages 221-225
Background. Pulmonary pleomorphic carcinoma (PPC) is a rare tumor of the lung and generally carries a poor prognosis. In addition, cases of PPC complicated by humoral hypercalcemia of malignancy (HHM) with an increased serum level of parathyroid hormone-related protein (PTHrP) produced by the tumor are rare. Case. A 59-year-old male smoker presented to us with a chief complaint of pain extending from the right shoulder to the back. Chest computed tomography (CT) showed an 11-cm mass shadow in the right apex area infiltrating the chest wall and an enlarged left adrenal gland. A CT-guided biopsy showed poorly differentiated tumor cells with sarcomatous changes, which led to the diagnosis of PPC (cT4N0M1b, clinical stage IV, ADR). When admitted for treatment, the patient developed mild consciousness disturbance and was found to have an increased serum level of PTHrP and hypercalcemia; based on these findings, the patient was diagnosed with HHM. He was administered an intravenous infusion of zoledronic acid in saline to control the hypercalcemia. After the serum calcium levels normalized, he was administered six courses of carboplatin+paclitaxel+bevacizumab combination chemotherapy. The chemotherapy proved effective. Conclusion. Although chemotherapy is known to have poor efficacy in patients with advanced PPC, three-drug combination therapy including bevacizumab proved useful in our patient.
