Paraneoplastic Hypocalcemia Developed in Gastric Cancer Accompanied by Osteoblastic Metastasis

Abstract

Paraneoplastic syndromes are generally defined as clinical disorders associated with malignant diseases, and hypocalcemia associated with cancer is a rare condition. A woman in her 60s was referred to our hospital for the further examination of massive ascites due to carcinoma of unknown primary origin. She complained of numbness around her lips, and marked hypocalcemia of 5.0 mg/dL was noted. After two courses of chemotherapy, computed tomography showed a decrease in the ascites, and her serum calcium level increased. Although hypocalcemia is a very rare condition in patients with gastric cancer, serum calcium values should be evaluated when neurological symptoms are observed.

Keywords: bone metastasis; gastric cancer; hypocalcemia.

Figure 1.

Contrast-enhanced CT showed massive ascites (a) and an abnormal bone formation adjacent to the thoracic spine (b, arrow).

Figure 2.

Bone scintigraphy demonstrated the increased uptake of ^99m-technetium diffusely throughout the skeleton, showing a ’beautiful bone scan’.

Figure 3.

Clinical course of the case. The serum calcium level was increased and the CEA level decreased due to chemotherapy.

Figure 4.

EGD demonstrated a slightly depressed pale lesion with fold convergence (a). In images with indigocarmine spray (b), encroachment and swelling of the converging folds were enhanced, and narrow band imaging with magnification (c) showed irregular microvessels on the surface of the lesion. Histopathology of a biopsy specimen showed a poorly differentiated tubular adenocarcinoma (d).