Cancer Res Treat.  2014 Jul;46(3):307-311.

Unusual Manifestation of Intravascular Large B-Cell Lymphoma: Severe Hypercalcemia with Parathyroid Hormone-Related Protein

• Ha JM
• Kim E
• Lee WJ
• Hwang JW
• Yune S
• Ko YH
• Choi JY
• Kim SJ
• Kim WS

Abstract

Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma. It usually presents with nonspecific symptoms, such as fever, rather than with overt lymphadenopathy. Reports of hypercalcemia, as the initial presentation of IVLBCL, are limited in the literature, despite it being a well-known complication of various solid cancers. We present a 68-year-old male with severe hypercalcemia and increased levels of serum parathyroid hormone-related protein. He was diagnosed with IVLBCL, involving the bone marrow and spleen, and was successfully treated with rituximab-containing chemotherapy. A few previous case reports have shown hypercalcemia in patients with IVLBCL. Much like our case, previous cases with hypercalcemia had advanced diseases, including bone marrow invasion. Although it was an extremely rare manifestation of IVLBCL, we suggest that IVLBCL should be a part of the differential diagnosis in patients with unexplained hypercalcemia. Therefore, an active work-up might be recommended, including positron emission tomography/computed tomography scan and bone marrow examination, which may be useful for early diagnosis.

Keyword

Intravascular lymphoma; Hypercalcemia; Parathyroid hormone-related protein

MeSH Terms

Aged
Bone Marrow
Bone Marrow Examination
Diagnosis, Differential
Drug Therapy
Early Diagnosis
Electrons
Fever
Humans
Hypercalcemia*
Lymphatic Diseases
Lymphoma, B-Cell*
Lymphoma, Non-Hodgkin
Male
Parathyroid Hormone-Related Protein*
Spleen
Parathyroid Hormone-Related Protein

Figure

• 

  Fig. 1. (A) Diffuse 18F-fluorodeoxyglucose (FDG) uptake can be seen in the bone marrow and spleen at the time of diagnosis. (B) Normalized FDG uptake can be seen in the same areas after the sixth cycle of chemotherapy.

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  Fig. 2. Histopathological findings (A and B, Wright Giemsa staining, ×400). (A) The bone marrow smear specimen shows increased numbers of histiocytes and hemophagocytosis. (B) The peripheral blood smear shows hemophagocytosis. Immunohistochemical staining for CD20 of the bone marrow biopsy specimen (C, ×400). (C) Lymphoma cells positive for CD20 invading sinusoids in the bone marrow.

Reference

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