Epidermoid carcinoma of the mandible associated with hypercalcemia: report of two cases

Abstract

Two cases of oral carcinoma associated with hypercalcemia are reportedwith a brief survey of nine similar cases. The first case was a 65-year-old man with an epidermoid carcinoma of the mandible (T4N3M0). The serum calcium which was 4.4mEq/l at the initial examination became 5.5mEq/l three weeks after resection of the primary lesion and neck dissection. Despite intensive therapy with a steroid and hydration, the serum calcium level was elevated to 9.9mEq/l in a month with concomitant hypophosphatemia and the patient suddenly died of cardiac arrest. The serum parathyroid hormone (PTH) level was increased to 1.7ng/ml, but the excised tumor tissue was negative for PTH. No abnormality of the parathyroid was noted during neck dissection. Postoperative bone scintigram with Tc showed radioisotope accumulation in the ileum and other bones, but metastasis was not confi rmed because of lack of radiolucency. PTH was most suspected as the cause of hypercalcemia but definite evidence, was not obtained. The second case was a 86-year-old woman with a recurrent epidermoid carcinoma (T4N3M0) of the mandible. The lesion was treated by irradiation. Lung metastasis became evident during the treatment and approximately three months later, an elevation of the serum calcium (6.0mEq/l) associated with leukocytosis (24, 600/cumm) was first noted. Although hypercalcemia was controlled by steroid and hydration therapy, blood leukocyte count constantly increased to 178, 000/cumm in two weeks and the patient finally died of kidney insufficiency. Hypercalcemia, in all likelihood, resulted from the tumor with colony-stimulating activity, but the precise mechanism was not elucidated. The importance of hypercalcemia in the treatment of patients with carcinoma of the oral region was stressed because the clinical symptoms and signs of hypercalcemia are often indistinguishable from those of advanced carcinoma with metastasis and toxicity of anti-tumor agents and radiotherapy.