1977 Volume 68 Issue 3 Pages 288-293
A 54-year-old woman with history of the radical operation for epipharynx carcinoma in 1969 was admitted to our hospital on December 5, 1974 for a remarkable weight loss with a right abdominal mass. An excretory urogram demonstrated a downward displacement of the major renal calices in the right side. A right renal arteriogram showed a huge renal mass with tumor staining and stretching of the vesseles, suggesting renal cell carcinoma. Roentgenographic surveys and bone scans for metastasis were negative. Repeated serum calcium determinations during this period ranged from 15.0 to 16.5mg% and serum phosphate levels from 3.2 to 3.6mg%. A radioimmunoassay for parathyroid hormone revealed 2.2ng/ml in peripheral blood (normal: under 0.5ng/ml). Right nephrectomy was carried out on December 12, 1974 and the histological examination showed a papillary cell type of adenocarcinoma. After the operation serum carcium levels remained elevated, ranging from 14.0 to 15.0mg%. The elevated calcium levels were controlled neither by massive fluid infusions nor hydrocorcison administration. Under the presumptive diagnosis of primary hyperparathyroidism, parathyroid scans and selective thyroid arteriography were performed, but they did not show any definite tumor mass. Slective venones sampling with radioimmunoassays for parathyroid hormone was carried out on April 1, 1975. The result revealed an increased concentration of parathyroid hormone in the left common jugular vein (13.0ng/ml) compared to other sites, right common jugular vein (2.0ng/ml), superior vena cava (1.9ng/ml), inferior vena cava (0.9ng/ml), and left renal vein (1.1ng/ml). Removal of parathyroid tumor was scheduled, but before the operation the patient died suddenly due to hypercalcemic crisis on May 10, 1975. Autopsy revealed recurrence of epipharynx carcinoma, a latent thyroid carcinoma, and a parathyroid adenoma at the left lower pole of the thyroid gland measuring 1.5×1.5×1.0cm. Radioimmunoassays of parathyroid hormone in extract of the metastatic tumors of the renal cell carcinoma were within normal limit.
