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

Abstract

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 T3N2M0 Stage 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.