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Introduction: Lung adenocarcinoma with parathyroid hormone (PTH)-related hypercalcemia is uncommon. Case Presentation: A 69-year-old man was admitted to our hospital due to anorexia and fatigue. Serum calcium (15.0 mg/dL) and carcinoembryonic antigen (361.7 ng/mL) were extremely high, and PTH-related protein (PTH-rP) also elevated (16.7 pmol/L). Systemic computed tomography revealed multiple enlarged lymph nodes and disseminated peritoneal nodules, with irregularly shaped nodules in the upper lobe in the left lung. Ultrasound-guided biopsy from the axillary lymph node revealed adenocarcinoma. Immunohistological staining showed the tumor cells to be positive for cytokeratin 7 and PTH-rP and negative for cytokeratin 20 and thyroid transcription factor-1. Although the primary origin remains undetermined despite detailed examinations, possible primary tumor was considered to be lung adenocarcinoma in the present case. The serum calcium level was reduced by denosumab, but the patient died 20 days after admission. Conclusion: The present case demonstrated the importance of considering oncological emergency, such as hypercalcemia and/or PTH-rP-producing hypercalcemia, in patients with adenocarcinoma. [ABSTRACT FROM AUTHOR]

Background: Sentinel lymph node biopsy (SNB) using radioisotopes is a standard method for assessing axillary lymph node status in patients with breast cancer. Although preoperative lymphoscintigraphy can estimate the number of sentinel lymph nodes (SNs), multiple radioactive SNs are often identified, even when lymphoscintigraphy reveals only one SN. Importantly, metastases are not always observed in the most radioactive SN (hottest SN). This study aimed to determine the significance of metastases in the second or less radioactive SNs when the hottest SN is negative., Methods: We retrospectively analyzed 114 patients with breast cancer with positive SNs who underwent axillary lymph node dissection. The clinicopathological characteristics, SN radioactivity, and axillary lymph node status were evaluated., Results: Twenty-six patients exhibited metastasis in the second or less radioactive SNs without metastasis in the hottest SN. These patients had a lower risk of non-SN metastasis compared with those with metastasis to the hottest SN (P=0.03). Multivariate analysis identified metastasis in the hottest SN [hazard ratio (HR) 4.93, P=0.01] and the detection of ≥2 SNs by lymphoscintigraphy (HR 3.36, P=0.01) as independent predictors of non-SN metastasis. None of the patients with only one lymph node detected by lymphoscintigraphy and metastasis to the second or less SNs without metastasis to the hottest SN showed non-SN metastasis., Conclusions: Patients with metastasis in the second or less radioactive SNs, but not in the hottest SN, have a lower risk of non-SN metastasis than those with a positive hottest SN. Combining radioactivity with lymphoscintigraphic information can enhance the accuracy of non-SN status prediction., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-346/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

A 61-year-old woman presented with metastatic breast cancer in her right lung 4 years and 11 months after the operation for her right breast cancer(HER2 enriched type). Chemotherapy(pertuzumab plus trastuzumab plus docetaxel)were ad- ministered. On day 2 of cycle 2, pegfilgrastim was administered because her neutrophils decreased to 54 cells/mL on day 8 of cycle 1. On day 9 of cycle 2, she developed left neck and chest pain. Moreover, she developed a fever of 39°C on day 14 and visited our hospital. Her WBC and CRP increased to 18,300 cells/mL and 25.48mg/dL, respectively. Computed tomography revealed an increased CT value of the panniculus, around the aorta and left pleural effusion. Ultrasonography of the neck showed a marginal hypoechoic area around the left carotid artery, which corresponded with the pain. Arteritis induced by PFG was suspected. The neck pain and fever almost completely improved 19 days later, and cycle 3 was performed 28 days after cycle 2. To our knowledge, the present case is the second report of arteritis that was suspected to be associated with PFG.