A Male Patient with Humoral Hypercalcemia of Malignancy (HHM) with Leukocytosis Caused by Cutaneous Squamous Cell Carcinoma Resulting from Recessive Dystrophic Epidermolysis Bullosa.
Recessive dystrophic epidermolysis bullosa (RDEB) is a severe skin disorder. Although the patients are at risk for cutaneous squamous cell carcinoma (SCC), no case of cutaneous SCC derived from RDEB with humoral hypercalcemia of malignancy (HHM) has been reported. We present the first case report of a male patient with HHM with leukocytosis caused by cutaneous SCC resulting from RDEB. A 20-yr-old Japanese male patient with RDEB; the diagnosis was confirmed by electron microscopic examination, suffered an intractable skin ulcer and hypercalcemia and leukocytosis. PTH-rP, SCC antigen and Granulocyte colony-stimulating factor (G-CSF) levels were elevated. The histological diagnosis of the skin lesion was made well-differentiated SCC. Immunohistochemical staining showed the expression of PTH-rP in atypical tumor cells. For the control of hypercalcemia before an amputation, we used zoledronate safely and could control the serum Ca concentration in the normal range. After the amputation of his right leg including SCC, leukocytosis improved immediately and PTH-rP in blood decreased to the normal range. One month after the amputation, local recurrence of cutaneous SCC and multiple lung metastases were observed. PTH-rP increased gradually associated with hypercalcemia. Although the patient reached an unfortunate turning point about 4 mo after the amputation, we propose that zoledronate is an effective and safe treatment for HHM with cardiorenal complications.
Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.
Kohji
K
Miura
Noriko
N
Umegaki
Taichi
T
Kitaoka
Takuo
T
Kubota
Noriyuki
N
Namba
Yuri
Y
Etani
Haruhiko
H
Hirai
Shigetoyo
S
Kogaki
Shigeo
S
Nakajima
Yuji
Y
Takahashi
Katsuto
K
Tamai
Ichiro
I
Katayama
Keiichi
K
Ozono
G-CSF; PTH-rP; hypercalcemia; quamous cell carcinoma; recessive dystrophic epidermolysis bullosa; zoledronate