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Case Reports
. 2021 Apr 28:2021:5525721.
doi: 10.1155/2021/5525721. eCollection 2021.

Hypercalcemia in Small Lymphocytic Lymphoma with an Elevated Parathyroid Hormone-Related Peptide Associated with Early Richter Transformation

Ashish Bains  1 , Pedro Covas  2 , Olga Timofeeva  3 , Michael Bromberg  4
Affiliations
Case Reports

Hypercalcemia in Small Lymphocytic Lymphoma with an Elevated Parathyroid Hormone-Related Peptide Associated with Early Richter Transformation

Ashish Bains et al. Case Rep Hematol. .

Abstract

Hypercalcemia in malignancy is associated with multiple mechanisms and occurs in up to 20-30% of cancer patients. We report a case of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) associated with hypercalcemia and an elevation in parathyroid hormone-related peptide (PTHrP) in the setting of a Richter transformation. Real-time reverse transcriptase PCR on lymph node biopsy specimens obtained before and after transformation showed an 8-fold increase in PTHrP mRNA levels and about 2-fold decrease in the levels of its cognate receptor PTHR1. The findings of this case suggest that parathyroid hormone-related peptide might be useful in monitoring a specific group of patients with SLL/CLL who develop hypercalcemia during the course of their disease and could suggest an autocrine-like mechanism involving PTHrP in Richter transformation.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
H&E sections of the lymph node excisional biopsy before transformation, demonstrating small round B-lymphocytes with clumped chromatin and rare mitosis (1a); Ki67 showing a low proliferation index (1b). 1c and 1d demonstrate increased cell size with numerous mitotic figures (arrowheads) and a significantly increased proliferation index by Ki67, respectively, at the time of early transformation. All images are taken at 400X magnification.
Figure 2
Figure 2
The mRNA expression of PTHrP and its receptor PTHR1 in the lymph nodes. The PTHrP levels increased, while PTHR1 levels have decreased in 2016 compared to 2013. The mRNA was extracted from formalin-fixed paraffin-embedded lymph node tissue collected in 2013 and 2016. The expression levels of PTHrT and PTHR1 were normalized using GAPDH expression levels. Each bar represents a mean of three independent experiments for one cell line; bars represent SD.
See this image and copyright information in PMC

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