Squamous cell carcinoma of the sigmoid colon presenting with severe hypercalcemia.

Primary squamous cell carcinoma of the colorectum is an unusual gastrointestinal cancer. These cancers have an uncertain pathogenesis, and the clinical literature provides limited information on the natural history and response to treatment. This report discusses a patient who presented with severe symptomatic hypercalcemia (21.08 mg/dL). Colonoscopy found a partially obstructing mass in the sigmoid colon, and computed tomography of the abdomen found hepatic metastasis and para-aortic lymphadenopathy. A liver biopsy established the diagnosis of metastatic squamous cell carcinoma. This patient’s hypercalcemia responded to the usual management strategies for hypercalcemia, including hydration, calcitonin, and pamidronate. The patient was treated with carboplatin, paclitaxel, and cetuximab. His posttreatment course was complicated by acute gastroenteritis, health caree associated pneumonia, and possible peritonitis. In addition, follow-up radiographic studies found progression of hepatic disease with development of ascites and peritoneal disease. He died 5 months after diagnosis. This case shows that patients with squamous cell carcinoma of the colon can develop severe symptomatic hypercalcemia. This possibility needs to be considered in patients who present with hypercalcemia and do not have obvious parathyroid disease or a malignancy usually associated with hypercalcemia, especially bronchogenic carcinoma. The best treatment regimens for these patients who are not surgical candidates are unclear. These patients need more systematic study, possibly through the development of a national registry.