Ovarian Clear-Cell Carcinoma Changing to Produce Parathyroid Hormone-Related Protein with Recurrence

Abstract

Background: Humoral hypercalcemia of malignancy is a metabolic phenomenon that is mediated by the paraneoplastic secretion of parathyroid hormone–related protein (PTHrP). Clear-cell carcinoma is known to be one of the most common histologic subtypes of ovarian tumor associated with hypercalcemia. An interesting case with recurrent clear-cell carcinoma of the ovary, changing into producing PTHrP, is described. Case: A 50-year-old woman was diagnosed with ovarian clear-cell carcinoma, stage IIIb, at primary surgery. Her preoperative CA-19-9 and CA-125 levels were elevated to 270 U/mL and 3400 U/mL, respectively, but her serum CA and PTHrP levels were within normal range. The removed ovarian lesion was significantly immunopositive for PTHrP. Seventeen years after the initial surgery, the patient complained of continuous nausea and right lower abdominal pain. An intrapelvic mass (4–5 cm) was detected, and laboratory studies showed extremely elevated levels of CA (14.1 mg/dL) and PTHrP (21.4 pmol/L; [normal is <1.1 pmol/L]). Her CA-19-9 and CA-125 levels remained within normal range. Results: This patient had a recurrence of intraperitoneal symptoms, and her recurrent tumor began to produce PTHrP, thus inducing hypercalcemia. Conclusions: Serum CA and PTHrP levels may be potential indicators of recurrence, when tumor marker levels are not stable and reliable as data for management of a patient with clear-cell carcinoma. (J GYNECOL SURG 27:277)