Granacher Nikki Charlotta Paul, Berneman Zwi N, Schroyens Wilfried, Van de Velde Ann L R, Verlinden Anke, Gadisseur Alain P A
Division of Hematology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
Exp Hematol Oncol. 2017 Apr 11;6:9. doi: 10.1186/s40164-017-0071-8. eCollection 2017.
Osteolytic bone lesions and hypercalcemia without peripheral blasts B-cell acute lymphoblastic leukemia (B-ALL) is reported in children but rarely seen in adults.
We describe the case of a 34-year old man presenting with hypercalcemia and symptomatic osteolytic bone lesions of vertebrae and ribs who was initially suspected as having a solid malignancy. Diagnostic work-up including peripheral blood examination, radiographic and nuclear studies could, however, not detect a primary tumor. Because of a mild thrombocytopenia and the lack of a primary focus, a bone marrow biopsy was performed leading to the diagnosis of Philadelphia chromosome positive precursor B-ALL. After correction of the hypercalcemia with intravenous fluid administration, corticoids and bisphosphonates, the patient was treated according to the HOVON 100 protocol achieving complete molecular remission after the first cycle of induction chemotherapy.
Hypercalcemia and osteolytic bone lesions are rare complications of adult B-ALL and can occur in the absence of peripheral blastosis. With this case report we would like to emphasize the importance of clinical awareness. Immediate treatment of hypercalcemia and initiation of antileukemic treatment is mandatory as a delay of diagnosis might pose a real and possible life-threatening risk in these patients.
儿童中报道过无外周原始细胞的溶骨性骨病变和高钙血症的B细胞急性淋巴细胞白血病（B-ALL），但在成人中很少见。
我们描述了一名34岁男性患者的病例，该患者出现高钙血症以及有症状的椎骨和肋骨溶骨性骨病变，最初被怀疑患有实体恶性肿瘤。然而，包括外周血检查、影像学和核医学检查在内的诊断性检查均未发现原发性肿瘤。由于轻度血小板减少且缺乏原发灶，遂进行骨髓活检，结果诊断为费城染色体阳性前体B-ALL。在通过静脉补液、使用皮质类固醇和双膦酸盐纠正高钙血症后，患者按照HOVON 100方案进行治疗，在诱导化疗的第一个周期后实现了完全分子缓解。
高钙血症和溶骨性骨病变是成人B-ALL的罕见并发症，可在无外周原始细胞增多的情况下发生。通过本病例报告，我们想强调临床意识的重要性。必须立即治疗高钙血症并开始抗白血病治疗，因为诊断延迟可能给这些患者带来真正且可能危及生命的风险。
