Primary Bone Marrow B-Cell Lymphoma Undetected by Multiple Imaging Modalities That Initially Presented with Hypercalcemia

Abstract

Purpose We report a rare case of severe hypercalcemia that was ultimately diagnosed as primary bone marrow diffuse large B-cell lymphoma (BCL). Case Report A 74-year-old male patient visited our hospital complaining of tenderness and swelling of the left knee caused by supracondylar fracture of the left distal femur. His initial blood tests showed a serum calcium level of 13.9 mg/dL, inorganic phosphorus of 4.34 mg/dL, and a serum creatinine level of 1.54 mg/dL. A serum assay of intact parathyroid hormone showed 5.24 pg/mL, and the patient's serum 25(OH)D level was 22.33 ng/mL. To exclude malignancy, we performed imaging studies, including abdomen or chest computed tomography and positron emission tomography-computed tomography; however, no suspicious lesion was found, although the serum PTH-related peptide level was elevated at 4.0 pmol/L. A bone marrow biopsy was performed to identify any hidden hematologic malignancy. As a result, the pathology of bone marrow confirmed the presence of atypical lymphocytes that stained positive for the CD20 marker, which is consistent with BCL involving the bone marrow. Conclusion This case highlights the importance of pursuing a thorough workup for rare underlying causes of hypercalcemia when parathyroid-related etiologies can be excluded.

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

“…There are several case reports that describe lymphomas presenting as severe, unexplained hypercalcemia [9-11, 24, 25]. Hong et al reported a case of DLBCL in a 72-year-old male who presented with worsening confusion and dehydration and who, like our case, was found to have severe hypercalcemia along with high plasma concentration of PTHrP.…”

“…Hypercalcemia has been reported in up to 15% of NHL patients during their clinical course but is uncommon at diagnosis [8]. Hypercalcemia has been described as a rare presenting symptom of patients with DLBCL in several case reports [9-11]. Presently, there is no published case report in the literature of THRLBCL presenting as severe hypercalcemia.…”

Aggressive Diffuse Intermediate Size B-Cell Lymphoma With P53 Mutation Presented as Primary Bone Marrow Lymphoma

“…There were 51 high-grade BCL cases, and among these 77% (48/62) were DLBCL and 5% (3/62) were left unclassifiable. 1,3,5-33 Meanwhile, there were 11 cases of low-grade BCL, and 11% (7/62) were FLs. 1,34,35 According to the character of our case, we focused more on the analysis of HGBL.…”

Bone Marrow Burkitt Lymphoma in a Child

“…Our patient only had a mild thrombocytopenia, whereas in most described cases a severe form of thrombocytopenia with anemia has been shown [ 13 ]. In addition, a hypercalcemia and hemophagocytic lymphohistiocytosis can also be a part of clinical presentation in patients with bone marrow lymphoma [ 11 , 14 ].…”