title: Combined hepatocellular-cholangiocarcinoma producing parathyroid hormone-related protein: report of a case.
abstract: Combined hepatocellular-cholangiocarcinoma (CHCC) is an uncommon form of primary liver cancer. A 57-year-old man was readmitted to our hospital for treatment of recurrent CHCC, 12 months after central bisegmentectomy and 4 months after limited hepatic resection. Magnetic resonance imaging (MRI) revealed multiple hepatic nodules. Laboratory data showed increased serum levels of α-fetoprotein (AFP), calcium, and parathyroid hormone-related protein (PTH-rP), to 5,571 ng/mL, 17.0 mg/dL, and 16.1 pmol/L, respectively. Palliative mass reduction surgery was indicated by the fact that the hypercalcemia was difficult to manage medically. Thus, we performed lateral segmentectomy with partial resection of segment 7 and the caudate lobe, and microwave coagulation therapy for multiple recurrent CHCC. Thereafter, the serum PTH-rP and AFP levels decreased remarkably and the hypercalcemia was controlled for the next 3 months. He died of disease progression 9 months after the last hepatic surgery. To our knowledge, this is only the second reported case of CHCC producing PTH-rP in the English-language literature.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan, mmatsumoto4@jikei.ac.jp.
authors.forename: Michinori
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Takeshi
authors.initials: T
authors.lastname: Gocho
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Mariko
authors.initials: M
authors.lastname: Itsubo
authors.forename: Masafumi
authors.initials: M
authors.lastname: Suzuki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D002118:Calcium / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery*; D017809:Fatal Outcome; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary; D010166:Palliative Care; D044162:Parathyroid Hormone-Related Protein / Q000096:biosynthesis* / Q000097:blood; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D044162:Parathyroid Hormone-Related Protein; D000509:alpha-Fetoproteins; D002118:Calcium