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FROM HYPERCALCEMIA TO ... OVARIAN CANCER

A. Draghici 1 , E. Petrova 2 , I. A. Voinea 1 , I. C. Raducu1 , G. Voicu 1 , R. Capota 1 , N. Dumitru 2 , A.
Dumitrascu 1 , A. Ghemigian 2

1 C.I. Parhon National Institute of Endocrinology, Bucharest, Romania,2 C.I.Parhon National Institute of
Endocrinology & C.Davila University of Medicine and Pharmacy, Bucharest, Romania

Objective: Ovarian tumors represent a vast, challenging, multidisciplinary field, with a particular poor
outcome for ovarian cancer(OC).(1-5) Malignancy-related hypercalcemia is a marker of severe prognostic.
(1-5) We aim to introduce a case detected with OC starting from hypercalcemia-related syndrome.

Method: Case report.

Case: A 75-year old female, known with arterial hypertension, type 2 diabetes mellitus, is admitted for
fatigue, nausea, lower abdominal distension, 9-kg weight loss/last year. Clinical exam:pelvic mass and
ascites. Blood assays: total serum calcium=11.1mg/dL(Normal:8.5–10mg/dL) (she denies vitamin
D/A/calcium supplements); normal TSH; PTH=84.9pg/mL(N:15-
65pg/mL);25OHD=10ng/mL(N>30ng/mL);normal bone turnover markers. Osteoporois confirmed by: L 2-
4 BMD-DXA=0.839g/sqcm, T-score=-3SDZ-score=-1.1SD. Computer tomography: left ovarian
tumor(14/10.5cm), peritoneal carcinomatosis, hepatic and pulmonary metastases, subchondral cysts in left
acetabulum(1.7/1.3cm), and areas of osteocondensation of L2(0.4cm),left iliac bone(0.5cm), right iliac bone
(0.55 cm). CA125=5439U/mL(N:0.1-35). Immunohistochemistry(IHC) based on cell block ascitic fluid:
positive WT1,ER=40%,PGRnegative,Ki67=45%(high grade serous adenocarcinoma). Vitamin D was added
to adjuvant dose-dense carboplatin and paclitaxel chemotherapy(6 cycles) followed by debulking
surgery(hysterectomy+salpingo-oophorectomy+omentectomy+local lymphadenectomy), then another 6
cycles. Post-operative histological and IHC profile confirmed the block cell profiling. BRCA1+2 tests were
negative so she became candidate to olaparib, a poly(ADP)-ribose polymerase inhibitor. After another
month of therapy, 18 F-FDG positron emission tomography/computed tomography (PET/CT) showed no
metabolic active lesions in pelvic area, neither thyroid gland, mammary gland, pulmonary, in liver, adrenals
or bones. Also, the value of CA125 normalized (=10U/mL), so was total serum calcium(=9.8mg/dL).
Conclusion: Nowadays, prompt recognition of a malignancy might embrace a clear beneficial of the outcome
even in severe cases like OC. Hypercalcemia may be related to bone metastases or paraneoplasic PTHrP
production.

Keywords: hypercalcemia, ovarian cancer

References:

1. Gheorghisan-Galateanu AA, et al. Acta Endocrinologica-Bucharest. 2017;3(3):356-63.

2. Popescu M, et al. Revista de Chimie. 2018;69(8):2089-9.
3. Albulescu DM, et al. Revista de Chimie. 2018;69(12):3683-7.
4. Poiana C. et al.Gynecological Endocrinology. 2010; 26(8):617-22.
5. Bechir ES, et al. Revista de Chimie. 2019;70(10):3515-7.