Hypercalcemia and leukocytosis are paraneoplastic syndromes occurring in association with malignant diseases but are uncommon in head and neck cancers. In the present paper, we report a clinical cousrse of a patient with tongue cancer accompanying with not only hypercalcemia but leukocytosis. We also describe the results of experiments in which we studied the mechanisms involved in pathogenesis of hypercalcemia and leukocytosis.
A 40-year-old man was seen in February, 1982 with a 2.1×1.8×1.2 squamous cell carcinoma (T₂N₀M₀) on the right side of his tongue. He received irradiation and chemotherapy first and then a resection of his tongue, jaw and neck 11 months later. He remained well almost for 6 months but was readmitted to the hospital with the complaint of severe back pain. Computed tomography film demonstrated a bony metastasis in third or fourth lumbar spine. At that time, his serum calcium level was 16 mg/dl and white blood cell count was 18, 000/mm³. A hypocalcemic hormone calcitonin failed to reverse serum calcium level. Serum levels of calcium-elevating hormones including parathyroid hormone, active metabolite of vitamin D₃ and prostaglandin E₃ determined by radioimmunoassay were all within normal range.
His serum serially purified by ultrafiltration, diafiltration and gel chromatography showed marked bone resorbing activity and colony stimulating activity. Peak activities of bone resorption and colony stimulation were eluted respectively at a molecular weight of approximately 20, 000 and 30, 000 dalton on Sephadex G-100 column. These activities were not detected in sera of other patients with cancer or acute inflammation and of normal individuals.
It was suggested that these activities found in the serum of the patients reported here might be responsible for the hypercalcemia and leukocytosis.