![]() The tumor generally presents with abrupt onset, severe symptoms and high serum calcium concentration of >14 mg/dl. Hypercalcemia of malignancy is not an uncommon etiology of hypercalcemia in an inpatient setting. The final diagnosis was advanced-stage squamous cell carcinoma of the right renal pelvis. There were inferior vena cava invasion and multiple metastases in both hepatic lobes and intra-abdominal lymph nodes. Computed tomography of the chest and abdomen showed an infiltrative tumor with extensive involvement of the right kidney, the right pelvocalyceal system, the right adrenal gland, the right lobe of the liver and the adjacent right hemidiaphragm and psoas muscle (fig. Histopathology was compatible with metastatic squamous cell carcinoma. In searching for the primary site of malignancy, a left supraclavicular lymph node biopsy was performed. There was minimal right pleural effusion on chest X-ray, with no abnormal pulmonary nodules. Thrombosis completely occluded the right leg and partially the left leg. Doppler ultrasound showed acute extensive deep vein thrombosis of both legs along the external iliac vein, the common femoral vein, the proximal deep femoral vein to the popliteal vein. Renal ultrasound visualized large right staghorn calculi and moderate left hydronephrosis with proximal hydroureter (fig. Unfortunately, we could not confirm the diagnosis with PTH-related protein (PTH-rP) due to test unavailability in our country. In the settings of old age, weight loss and deep vein thrombosis, humoral hypercalcemia of malignancy was mostly suspected. Serum intact parathyroid hormone (PTH) was investigated and found to be 11.5 pg/ml (reference range 15–65). Her corrected calcium adjusted with albumin was 15.93 mg/dl. Furthermore, blood chemistries revealed serum total calcium of 14.8 mg/dl (reference range 8.5–10.1), serum phosphorus of 3 mg/dl (reference range 2.5–4.9) and serum creatinine of 2 mg/dl (reference range 0.67–1.17). Urinary examination showed a pH of 5, white blood cells of 1–2/high-power field and red blood cells of 0–1 cells/high-power field. She had nonpitting edema on both legs that was more pronounced on the right leg with the presence of Homan's sign. Two lymph nodes, 0.7 and 1 cm in diameter, were palpated in the left supraclavicular area. Her blood pressure was 160/87 mm Hg and her pulse rate was 93 beats/min. On examination, the patient appeared lethargic and dehydrated. b Retrograde pyelogram showed right staghorn renal calculi with partial obstruction and left middle ureter stricture. She was rehydrated with normal saline and then referred to our hospital for relief of left ureteric obstruction.Ī KUB X-ray visualized a large right staghorn stone. Serum blood urea nitrogen and creatinine were 52 mg/dl (reference range 7–18) and 6.8 mg/dl (reference range 0.67–1.17), respectively. A diuretic renal scan was interpreted as a nonfunctioning right kidney and fair renal function of the left kidney. (fig.1a), 1a), and a retrograde pyelogram showed right staghorn renal calculi with partial obstruction and left middle ureter stricture (fig. Kidney, ureter and bladder (KUB) X-ray visualized a large right staghorn stone (fig. The patient was admitted to another hospital for investigation. There was no history of malignancy in her family. She was a passive smoker and did not drink alcohol. Her medical conditions were hypertension and dyslipidemia, and she was receiving treatment with amlodipine and simvastatin. For 2 months prior to admission, she had had intermittent right upper abdominal pain, vomiting, constipation, anorexia and significant weight loss. A 79-year-old female presented with gradual deterioration of mental status for 1 month. ![]()
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