Esophageal carcinoma with high serum parathyroid hormone-related protein (PTHrP) level

We report two patients with esophageal carcinoma with high levels of serum parathyroid hormone-related protein (PTHrP). Patient 1 was a 66-year-old ma n in whom the serum calcium level was also high, and patient 2 was an 81-ye ar-old woman. The serum PTHrP level was 411 pM (normal range, 13.8-55.3 pM) in patient 1 and 94.5 pM in patient 2 (in whom the serum granulocyte colon y-stimulating factor level was also high). We demonstrated PTHrP immunohist ologically in esophageal carcinoma cells in both patients. After admission, patient 1 died of pneumonia on the 17th day of hospitalization (the 48th d ay after he had had an episode of frequent hiccuping) and patient 2 died of acute circulatory failure on the 12th day of hospitalization (the 25tb day after she had vomited after a meal). Neither of these patients died of can cer. Pneumonia in patient 1 was believed to be due to weakened body defense s, while the acute circulatory failure in patient 2 was due to emaciation. Since esophageal carcinoma with humoral hypercalcemia of malignancy and leu kocytosis is characterized by rapid progression and metastasis, early diagn osis and treatment are mandatory.