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Background Information

A 57-year old woman was admitted in a delirious state and obtuned consciousness. Prior medical history was unremarkable.

Neurological examination revealed focal seizures of the right upper limb, a mild right hemiparesis, and a positive Babinski sign bilaterally. Verbal communication was not possible and the case history was obtained from relatives.

Laboratory examination showed increased calcium levels with a maximum of 3,69 mmol (normal values 2.0-2.7 mmol/l), as well as an elevated CRP > 250 mg (normal values: 0.8-5.0mg) and elevated tumour markers (CEA and CA 125).

Brain MRT exhibited T2 hyperintense signal in the posterior lobes. Cerebral metastases were unlikely, and the images were compatible with posterior reversible encephalopathy syndrome (PRLS).

Computer tomography (CT) of the abdomen indicated a large gynaecological tumour with metastases in the liver, lung and vertebral column. A CT-guided biopsy confirmed the diagnosis of malignancy.

Although calcium levels returned to normal values the soporous state and focal seizures persisted despite anticonvulsant therapy and the patient died due to aspiration pneumonia 10 days after admission.

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What was the abdominal tumour?

• Uterus carcinoma
• Sarcoma
• Lymphoma
• Unrelated