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Expression of parathyroid hormone‐related protein (PTHrP) in multiple myeloma
Author(s) -
Kitazawa Riko,
Kitazawa Sohei,
Kajimoto Kazuyoshi,
Sowa Hideaki,
Sugimoto Toshitsugu,
Matsui Tosimitsu,
Chihara Kazuo,
Maeda Sakan
Publication year - 2002
Publication title -
pathology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 74
eISSN - 1440-1827
pISSN - 1320-5463
DOI - 10.1046/j.1440-1827.2002.01314.x
Subject(s) - parathyroid hormone related protein , multiple myeloma , parathyroid hormone , medicine , bone resorption , endocrinology , osteolysis , paracrine signalling , hypercalcaemia , bone marrow , pathology , malignancy , calcium , receptor , surgery
Multiple myeloma is a plasma cell neoplasia often associated with multiple skeletal lesions and hypercalcemia. Several cytokines, including interleukin (IL)‐1, IL‐6 and tumor necrosis factor‐β (TNF‐β), derived from myeloma cells are thought to accelerate osteoclastic bone resorption and cause hypercalcemia through a paracrine mechanism. We report on a case of a 69‐year‐old man with multiple myeloma associated with hypercalcemia and advanced osteolytic lesions. After bisphosphonate treatment and MP (melphalan and prednisolone) therapy, the patient’s serum calcium level was successfully but transiently recovered to the normal range. Biochemical analysis showed a remarkable increase in serum parathyroid hormone‐related protein (PTHrP; 3.7 pmol/L) and IL‐6 (22.0 pg/mL). On the other hand, parathyroid hormone and 1α,25(OH) 2 vitamin D 3 were suppressed. By immunohistochemistry and in situ hybridization on aspiration‐biopsied bone marrow clot sections, PTHrP mRNA and protein were detected in the cytoplasm of myeloma cells. The rate of PTHrP‐positive myeloma cells was estimated to be at least one‐third. Since PTHrP can, as an endocrine factor, systemically act on bone and kidney, hypercalcemia in this case might have been caused through both local osteolytic hypercalcemia and humoral hypercalcemia of malignancy mechanisms.