Hypercalcemia in Upper Urinary Tract Urothelial Carcinoma : A Case Report and Literature Review

Abstract EN

Objective.

We here report a patient with upper urinary tract urothelial carcinoma with hypercalcemia likely due to elevated 1,25-dihydroxyvitamin D.

Methods.

We present a clinical case and a summary of literature search.

Results.

A 57-year-old man, recently diagnosed with a left renal mass, for which a core biopsy showed renal cell carcinoma, was admitted for hypercalcemia of 11.0 mg/mL He also had five small right lung nodules with a negative bone scan.

Both intact parathyroid hormone and parathyroid hormone-related peptide were appropriately low, and 1,25-dihydroxyvitamin D was elevated at 118 pg/dL.

The patient’s calcium was normalized after hydration, and he underwent radical nephrectomy.

On the postoperative day 6, a repeat 1,25-dihydroxyvitamin D was 24 pg/mL with a calcium of 8.1 mg/dL.

Pathology showed a 6 cm high-grade urothelial carcinoma with divergent differentiation.

We identified a total of 27 previously reported cases with hypercalcemia and upper tract urothelial carcinoma in English.

No cases have a documented elevated 1,25-dihydroxyvitamin D level.

Conclusion.

This clinical course suggests that hypercalcemia in this case is from the patient’s tumor, which was likely producing 1,25-dihydroxyvitamin D.

Considering the therapeutic implications, hypercalcemia in patients with upper urinary tract urothelial carcinoma should be evaluated with 1,25-dihydroxyvitamin D.