Hypercalcemia associated with renal cell carcinoma: probable role of neoplastic stromal cells

Renal adenocarcinoma with tumour thrombi in the inferior vena cava and right atrium in a pedestrian motor vehicle accident fatality: case report and medicolegal implications

Dramatic and unexpected natural disease processes may occasionally be encountered in the course of routine forensic pathology practice. The pathophysiological consequences of these processes may carry profound medicolegal implications which may have a bearing on the liability and culpability of the various parties involved. A pedestrian-vehicular incident involving a 53-year-old woman in whom a renal adenocarcinoma with tumour extension to the inferior vena cava and right atrium was discovered at autopsy is reported. The pathophysiological and biochemical disturbances associated with this tumour are discussed and their possible medicolegal implications evaluated.

The incidence and prognostic significance of humoral hypercalcemia in renal cell carcinoma

This retrospective study was conducted to evaluate the incidence and prognostic significance of humoral hypercalcemia in 218 renal cell carcinoma patients during the last 20 years. Of 218 patients 20 (9.2%) were hypercalcemic, with serum calcium levels ranging from 10.7 to 16.0 mg./dl. The respective incidence of humoral hypercalcemia was 3% in patients with stage I, 5.9% with stage II, 14.1% with stage III and 18.9% with stage IV disease without bone metastasis. The survival curves between the hypercalcemic and eucalcemic groups among stages I to III cancer patients showed no statistical significance (p greater than 0.05). The survival curve deteriorated significantly in stage IV cancer patients with humoral hypercalcemia (p less than 0.005), with a median survival of 45.0 +/- 39.7 days versus 286.4 +/- 27.6 days in eucalcemic patients. No specific correlation was found between pathological cell type and humoral hypercalcemia.

Hypercalcemia in childhood renal tumors

Hypercalcemia is an uncommon complication of childhood renal tumors. It is exclusively seen in infants 6 months of age or younger with malignant rhabdoid tumor of the kidney (MRTK) or congenital mesoblastic nephroma (CMN). Secretion of parathormone or prostaglandin E2 by the tumor cells is responsible for the hypercalcemia in most of these patients. Bone metastasis has been notably absent in these patients, and the hypercalcemia completely resolves with the removal of the tumor. Hypercalcemia in itself probably does not have any prognostic significance; however, it may serve as a tumor marker in some patients. Early recognition and effective management of this complication may prevent the acute life-threatening as well as the longstanding complications of this serious metabolic disorder.