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AB0157 Paraneoplasic hypercalcemia complicating a b cell non-hodgkin lymphoma (nhl)
  1. E Karoubi Nordon,
  2. E Palazzo,
  3. SA Rouidi,
  4. O Meyer
  1. Rhumatology, BICHAT, Paris, France

Abstract

Background Hypercalcemia is an unfrequent manifestation of B cell NHL. We describe a case report of hypercalcemia secondary to PTH-rp production, inaugurating a B-cell NHL.

Objectives A 77 year old woman was admitted with dorsalgia. Physical examination was negative except neuropsychological hyperexcitability.

Biological data rrevealed an increased calcemia (4.2 mmol/l) with decreased phosphoremia (0.45 mmol/l) suggesting a hyperparathyroidism. However, PTH(RIA) was low (3.5 pg/ml, N = 11.0–62.0) and 1.25(oh)2d3 level was in the normal range (40 yg/l, N = 15–80). PTH-rp was moderatly increased (2.1 ymol/l, N < 1.5). Bone marrow aspiration was normal. No sign for osteolysis was present on bone X-ray, CT scan and MRI. The abdominal CT scan and abdominal MRI revealed a retroperitoneal mass. A needle biopsy was diagnostic for NHL B type. LDH were elevated to 3290U/l (n < 470). Other lymphoid tissue involvment was limited to the spleen. IV farmidronate was successfuly adminitred for treatment of hypercalcemia.

Results Malignat hypercalcemia occurs in 14p.cent of leukaemia and lymphoma. Among NHL, T cell lymphoma positive for HTLV-1, are more frequently associated with hypercalcemia mediated by production of 1–25(OH)2D3 or lymphotoxin/OAF. Less than 3p.cent of B cell NHL are associated with a paraneoplasic hypercalcemia. Two hypercalcemic mediators have been caracterised: PTH-rp and/or OAF

Conclusion Humoral hypercalcemia mediated by PTH-rp is a rare complication of B cell-NHL. Hypophosphatemia with a decreased PTH plasma level must alert for this mechanism.

References

  1. Orcel P. Hypercalcémie des affections malignes, ed. Masson, 1996

  2. Daroszewska A, Bucknall RC, Chu P, Fraser WD. Severe hypercalcemia in B-cell Lymphoma: combined effects of PTH-rp, IL-6 and TNF. Postgrad Med J. 1999

  3. Hanihara T, Takahashi T. PTH-rp associated Hypercalcemia in probable intravascular lymphoma of B-cell type. Am J Hematol. 1996

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