Conte Gabriella A, Harmon Jonathan S, Le Marjolein L, Sun Xiu, Schuler Jake W, Levitt Michael J, Chinnici Angelo A, Hossain Mohammad A
Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, NJ, USA.
Department of Medicine, Jefferson Health New Jersey, Jefferson University Hospital, Stratford, NJ, USA.
World J Oncol. 2019 Dec;10(6):231-236. doi: 10.14740/wjon1246. Epub 2019 Dec 16.
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.
富于T细胞/组织细胞的大B细胞淋巴瘤（THRLBCL）是弥漫性大B细胞淋巴瘤（DLBCL）中一种极其罕见的形态学亚型，仅占所有病例的1%-3%。它被认为是一种侵袭性淋巴瘤，预后较差。在几例病例报告中，高钙血症被描述为DLBCL患者不常见的首发症状。在此，我们报告一例罕见的严重高钙血症病例，该患者最终被诊断为富于T细胞/组织细胞的B细胞淋巴瘤。一名69岁男性患者因恶心、呕吐、乏力和非故意体重减轻前来我院就诊。他最初的血液检查显示血清钙水平为16.1mg/dL，血清肌酐水平为3.25mg/dL。他的全段甲状旁腺激素水平较高（PTH，6.8pg/mL），25-羟维生素D和血清甲状旁腺激素相关肽（PTHrP）轻度升高。为排除恶性肿瘤，对胸部、腹部和骨盆进行了计算机断层扫描（CT），结果未见异常。进行了骨髓活检以检测任何隐匿的血液系统恶性肿瘤，结果显示有大的单核细胞，核仁突出，偶见里-施细胞，符合THRLBCL的诊断。随后的正电子发射断层扫描显示弥漫性氟脱氧葡萄糖（FDG）摄取。本病例报告了一种罕见的非霍奇金淋巴瘤亚型的独特表现。我们强调了对高钙血症病因进行全面检查以及了解恶性肿瘤中严重高钙血症潜在机制的重要性。
