title: Hepatocellular Carcinoma Without Cirrhosis Presenting With Hypercalcemia: Case Report and Literature Review.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) in non-cirrhotic livers is an uncommon finding and can present insidiously in patients. Another uncommon finding in HCC, and one of poor prognosis, is the presence of paraneoplastic diseases such as hypercalcemia. We report a case of a 66-year-old previous healthy Filipina woman who after routine laboratory evaluation was discovered to have hypercalcemia as the first sign of an advanced HCC without underlying cirrhosis. Because of the patient's relative lack of symptoms, healthy liver function, lack of classical HCC risk factors, and unexpected hypercalcemia, the diagnosis of a paraneoplastic syndrome caused by a noncirrhotic HCC was unanticipated.
  
  
  METHODS
  Case Analysis with Pubmed literature review.
  
  
  RESULTS
  It is unknown how often hypercalcemia is found in association with HCC in a non-cirrhotic liver. However, paraneoplastic manifestations of HCC, particularly hypercalcemia, can be correlated with poor prognosis. For this patient, initial management included attempts to lower calcium levels via zoledronate, which wasn't completely effective. Tumor resection was then attempted however the patient expired due to complications from advanced tumor size.
  
  
  CONCLUSIONS
  Hypercalcemia of malignancy can be found in association with non-cirrhotic HCC and should be considered on the differential diagnosis during clinical work-up.
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Neil B
authors.initials: NB
authors.lastname: Newman
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
authors.affiliation: Department of Pathology Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Jane Date C
authors.initials: JD
authors.lastname: Hon
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Berman
authors.affiliation: Department of Pathology Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
authors.forename: Deen
authors.initials: D
authors.lastname: Malik
authors.affiliation: Division of Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Carpizo
authors.affiliation: Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Moss
keywords: AFP, alpha-fetoprotein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CEA, carcinoembryonic antigen; HCC, hepatocellular carcinoma; HHM, hypercalcemia of malignancy; PTH, parathyroid hormone; PTHrP, parathyroid hormone related peptide; bisphosphonate; hepatocellular carcinoma; humoral hypercalcemia of malignancy; non-cirrhotic liver; paraneoplastic syndrome