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Case Report
Aggressive PTH-secreting lung carcinoma with a BRD3: NUTM1 fusion presenting with refractory hypercalcemia
1 Resident Doctor, Guy’s and St Thomas’ NHS Foundation Trust, Medical Oncology, London, United Kingdom
2 Department of Histopathology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
3 Respiratory consultant, University Hospital of Lewisham, Lewisham High Street, London, United Kingdom
4 Oncology consultant, Cancer Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom; School of Cancer and Pharmaceutical Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London, United Kingdom
5 Oncology consultant, Cancer Centre at Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
Address correspondence to:
Rosa Evans
St Thomas Hospital, Westminster Bridge Road, London SE1 7EH,
United Kingdom
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Article ID: 100148Z10RE2025
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Evans R, Abbotts K, Mclean E, Simpson T, Georgiou A, Gennatas S. Aggressive PTH-secreting lung carcinoma with a BRD3: NUTM1 fusion presenting with refractory hypercalcemia. J Case Rep Images Oncology 2025;11(2):6–10.ABSTRACT
Introduction: Nuclear protein in testis (NUT) midline carcinomas (NMCs) are rare and aggressive cancers. These carcinomas are defined by gene re-arrangement leading to fusion of the NUT gene on chromosome 15 with other genes. These are named as such as they are solid tumors most frequently occurring in the midline including lung, central nervous system, kidneys, head and neck. They are underdiagnosed and under-reported, with most available literature on them in the form of case reports and case series. There are currently no targeted treatments available, and as a result they are associated with poor outcomes. We report an unusual case of this cancer type: a BRD3::NUTM1 fusion lung cancer presenting with refractory hypercalcemia secondary to parathyroid hormone-related protein (PTHrP) secretion. Both the fusion partner, and the presentation of this case of NMC carry particular rarity.
Case Report: A 51-year-old female patient presented to her local Emergency Department with palpitations and was found to have a severely elevated calcium at 4.8 mmol/L (normal range 2.20–2.60 mmol/L). She was admitted and treated aggressively with intravenous fluids, zoledronic acid and denosumab. Her parathyroid hormone (PTH) was suppressed, but her PTHrP was too high to be measured. Further investigation in the form of a computed tomography (CT) chest, abdomen, and pelvis identified a large pulmonary mass and multiple bony metastases. The patient’s calcium level proved resistant to medical treatment, and her consciousness level reduced, leading to admission to Intensive Care for hemofiltration. An endobronchial biopsy and tumor molecular diagnostics identified the presence of a rare BRD3::NUTM1 fusion. Despite correction of her calcium, the patient did not regain full consciousness, and the difficult decision was made to stop active treatment.
Conclusion: This case describes a rare fusion pulmonary NMC presenting with hypercalcaemia and PTHrP secretion. It adds to the literature surrounding this aggressive cancer type, and highlights the need for early tissue diagnosis and immunohistochemistry in atypical and aggressive lung cancers.
Keywords: BRD3, Hypercalcemia, NUTM1, PTHrP
SUPPORTING INFORMATION
Acknowledgments
We would like to thank the next of kin of this patient, who gave their informed consent for the use and disclosure of her health information here.
Artificial intelligence (AI) use in the article: none.
Rosa Evans - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Keziah Abbotts - Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Emma Mclean - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Thomas Simpson - Acquisition of data, Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Alexandros Georgiou - Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published
Spyridon Gennatas - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Rosa Evans et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
