Combined hepatocellular–cholangiocarcinoma producing parathyroid hormone-related protein: report of a case

• Published in: Surgery today (Tokyo, Japan) Vol. 44; no. 8; pp. 1577 - 1583
• Main Authors: Matsumoto, Michinori, Wakiyama, Shigeki, Shiba, Hiroaki, Gocho, Takeshi, Misawa, Takeyuki, Ishida, Yuichi, Itsubo, Mariko, Suzuki, Masafumi, Yanaga, Katsuhiko
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-08-2014
• Subjects: alpha-Fetoproteins - analysis; Biomarkers, Tumor - analysis; Biomarkers, Tumor - blood; Calcium - blood; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - metabolism; Carcinoma, Hepatocellular - surgery; Case Report; Cholangiocarcinoma - diagnosis; Cholangiocarcinoma - metabolism; Cholangiocarcinoma - surgery; Fatal Outcome; Hepatectomy - methods; Humans; Liver Neoplasms - diagnosis; Liver Neoplasms - metabolism; Liver Neoplasms - surgery; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Multiple Primary; Palliative Care; Parathyroid Hormone-Related Protein - biosynthesis; Parathyroid Hormone-Related Protein - blood; Surgery; Surgical Oncology; Hypercalcemia; Combined hepatocellular–cholangiocarcinoma; Paraneoplastic syndrome; Parathyroid hormone-related protein
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-013-0714-2

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.