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. 2010 Oct 19:4:330.
doi: 10.1186/1752-1947-4-330.

Hypercalcemia and huge splenomegaly presenting in an elderly patient with B-cell non-Hodgkin's lymphoma: a case report

Ali Am Ghazi  1 , Hamid Attarian, Shirin Attarian, Abolghasem Abasahl, Ebrahim Daryani, Ebrahim Farasat, Marina Pourafkari, Farrokh Tirgari, Siavash M Ghazi, Kalman Kovacs
Affiliations

Hypercalcemia and huge splenomegaly presenting in an elderly patient with B-cell non-Hodgkin's lymphoma: a case report

Ali Am Ghazi et al. J Med Case Rep. .

Abstract

Introduction: Hypercalcemia is the major electrolyte abnormality in patients with malignant tumors. It can be due to localized osteolytic hypercalcemia or elaboration of humoral substances such as parathyroid hormone-related protein from tumoral cells. In hematological malignancies, a third mechanism of uncontrolled synthesis and secretion of 1-25(OH)2D3 from tumoral cells or neighboring macrophages may contribute to the problem. However, hypercalcemia is quite unusual in patients with B-cell non-Hodgkin's lymphoma.

Case presentation: An 85-year-old Caucasian woman presented with low grade fever, anorexia, abdominal discomfort and fullness in her left abdomen for the last six months. She was mildly anemic and complained of fatigability. She had huge splenomegaly and was hypercalcemic. After correction of her hypercalcemia, she had a splenectomy. Microscopic evaluation revealed a malignant lymphoma. Her immunohistochemistry was positive for leukocyte common antigen, CD20 and parathyroid hormone-related peptide.

Conclusion: Immunopositivity for parathyroid hormone-related peptide clearly demonstrates that hypersecretion of a parathyroid hormone-like substance from the tumor had led to hypercalcemia in this case. High serum calcium is seen in only seven to eight percent of patients with B-cell non-Hodgkin's lymphoma, apparently due to different mechanisms. Evaluation of serum parathyroid hormone-related protein and 1-25(OH)2D3 can be helpful in diagnosis and management. It should be noted that presentation with hypercalcemia has a serious impact on prognosis and survival.

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Figures

Figure 1
Figure 1
An abdominal CT scan of the patient during the first hospital admission.
Figure 2
Figure 2
PTHrP immunostaining.
Figure 3
Figure 3
H&E staining (hematoxylin and eosin staining).
Figure 4
Figure 4
A CT scan of the patient one year after surgery.
See this image and copyright information in PMC

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