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Case Reports
. 2019 Dec;10(6):231-236.
doi: 10.14740/wjon1246. Epub 2019 Dec 16.

Hypercalcemia in T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: An Unusual Presentation of a Rare Disease and Literature Review

Gabriella A Conte  1 , Jonathan S Harmon  2 , Marjolein L Le  3 , Xiu Sun  4 , Jake W Schuler  5 , Michael J Levitt  1 , Angelo A Chinnici  1 , Mohammad A Hossain  1
Affiliations
Case Reports

Hypercalcemia in T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: An Unusual Presentation of a Rare Disease and Literature Review

Gabriella A Conte et al. World J Oncol. 2019 Dec.

Abstract

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is an extremely rare morphologic subtype of diffuse large B-cell lymphoma (DLBCL), accounting for only 1-3% of total cases. It is considered an aggressive lymphoma with a poor prognosis. Hypercalcemia has been described as an uncommon presenting symptom of patients with DLBCL in several case reports. Here, we report an unusual case of severe hypercalcemia in a patient who was ultimately diagnosed with T-cell/histiocyte-rich B-cell lymphoma. A 69-year-old male patient presented to our hospital with nausea, vomiting, weakness and unintentional weight loss. His initial blood tests showed a serum calcium level of 16.1 mg/dL and serum creatinine level of 3.25 mg/dL. He had high intact parathyroid hormone (PTH, 6.8 pg/mL), mildly elevated 25-hydroxyvitamin D and serum PTH-related peptide (PTHrP). To exclude malignancy, computed tomography (CT) scans of the chest, abdomen and pelvis were performed which were unremarkable. A bone marrow biopsy was performed to detect any hidden hematologic malignancy which showed large mononuclear cells with prominent nucleoli and occasional Reed-Sternberg cells, consistent with the diagnosis of THRLBCL. Subsequent positron emission tomography demonstrated diffuse fluorodeoxyglucose (FDG) uptake. This case reports a unique presentation of a rare subtype of non-Hodgkin's lymphoma. We highlight the importance of pursuing a thorough workup for causes of hypercalcemia as well as understanding the underlying mechanisms of severe hypercalcemia in malignancy.

Keywords: Diffuse large B-cell lymphoma; Hypercalcemia; Malignancy; T-cell/histiocyte-rich large B-cell lymphoma.

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Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Figures

Figure 1
Figure 1
Bone marrow smears demonstrating T-cell/histiocyte rich large B-cell lymphoma. (a) Low-power view. (b) High-power view. (c) PAX8 immunostain. (d) CD3 immunostain. CD: cluster of differentiation. BUN: blood urea nitrogen; eGFR: estimated glomerular filtration rate; WBC: white blood cell; MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin.
Figure 2
Figure 2
Torso positron emission tomography/computed tomography scan demonstrates diffuse fluorodeoxyglucose (FDG) uptake and a 3.98-cm splenic mass.
See this image and copyright information in PMC

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