Abstract
A case of recurrent tongue cancer associated with DIC (disseminated intravascular coagulation) under treatment of hypercalcemia of malignancy is reported.
A 38-year-old man was seen in December, 1984 with a 44×25×16 (mm) moderately differentiated epidermoid carcinoma (T3 Ni MO) on the right side of the tongue. As he refused the operation, interstitial radiotherapy to the primary lesion and chemotherapy were initialy carried out. Four months after the first medical examination, right radical neck dissection was carried out. When recurrent tumor was found in the right neck, it was treated by chemotherapy, hyperthermia, and radiation. Immediately after radiotherapy, elevation of the serum calcium associated with leukocytosis was noted. The highest serum calcium level was 19.7mg/dl and leukocyte was 23400/mm3. But serum levels of calcium elevating hormones (PTH-C, 1, 25 dihydroxyvitamin D3, 25 hydroxyvitamin D3) and plasma levels of ones (PTH-N, prostaglandin E2) were both within normal range, Ga and Tc scintigram showed no radioisotope accumulation in bones.
Hypercalcemia was treated by calcitonin and hydration of normal saline solution. Under the treatment of hypercalcemia, abnormal bleeding from the injection spot was found and at the same time abnormalities of coagulation was noticed. From the laboratory findings, DIC could be diagnosed, and FOY (1g/day) and heparin (15000 U/day) were administered. But after about a month from onset of hypercalcemia the patient died of heart failure. In his autopsy a remarkable carcinomatous pericarditis was found, and the cause of his death was heart failure induced by it.
