Hypercalcemia of malignancy

Case contributed by Dr Vineet Prakash

Presentation

Patient presents with general malaise and vague aches. Blood test results show hypercalcaemia.

Patient Data

Age: 70 years
Gender: Female
X-ray
  • There is a lytic deposit in the upper right humerus.
  • No other lytic lesion is identified on this film.
  • The lungs are clear
CT
  • Focal destruction and abnormal soft tissue infiltration is seen in the proximal right humerus in keeping with known pathological fracture and tumor infiltration
  • No other focal bone lesion is demonstrated
  • 2 cm segment VII liver lesion is ill-defined and concerning
    for metastasis
  • 11 cm irregular exophytic right upper pole renal mass noted
  • Abnormal soft tissue is seen in the right suprarenal region
  • The right adrenal gland cannot be clearly identified and is thought to be infiltrated
  • Perinephric extension of the renal tumor and there are abnormal filling defects seen within the IVC compatible with tumor thrombus
  • Normal appearances of the left kidney, left renal vein, left adrenal and the remaining solid abdominal visceral organs
     

Case Discussion

The CT appearances are highly compatible with a renal cell carcinoma with a strong concern for metastases of:

  • Liver
  • Bone
  • Lung

There is evidence of IVC tumor extension therefore if proven to be RCC this is at least stage T3.

The hypercalcemia thus appears to be hypercalcemia of malignancy and the patient was followed up at the hematology MDT and urology MDT.

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Case information

rID: 31346
Published: 7th Nov 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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