Follicular lymphoma presenting with hypercalcaemia: an unusual mechanism of hypercalcaemia

Acta Clin Belg. 2015 Jun;70(3):200-3. doi: 10.1179/2295333714Y.0000000106. Epub 2014 Dec 4.

Abstract

Hypercalcaemia is a frequent finding in patients with cancer. In up to 30% of malignancies, the disease course is complicated with hypercalcaemia. For hospitalized patients, cancer is the most common cause of hypercalcaemia. In normal physiological circumstances, the ionized calcium is kept in check by the influence of two important hormones, parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,25(OH)2D). However, cancer can misbalance the calcium homeostasis by generating certain humoural mediators. Overproduction of parathyroid hormone-related peptide (PTH-rp), intact PTH, 1,25(OH)2D, and cytokines all cause hypercalcaemia. Hypercalcaemia is frequent in certain haematological cancers such as multiple myeloma and aggressive lymphomas. But hypercalcaemia is rare in patients with indolent lymphomas such follicular lymphoma. This case illustrates as a first to our knowledge the involvement of cytokines and chemokines in the pathophysiology of lymphoma-related hypercalcaemia. A pathophysiological mechanism is offered based upon the current understanding of cytokines and chemokines related to follicular lymphoma.

Keywords: Hypercalcaemia,; Indolent lymphoma,; Pathophysiology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Bone Density Conservation Agents / administration & dosage
  • Calcitonin / administration & dosage*
  • Chemokines / blood*
  • Cytokines / blood*
  • Diphosphonates / administration & dosage*
  • Diuretics / administration & dosage
  • Female
  • Furosemide / administration & dosage*
  • Humans
  • Hypercalcemia* / blood
  • Hypercalcemia* / diagnosis
  • Hypercalcemia* / etiology
  • Imidazoles / administration & dosage*
  • Lymphoma, Follicular* / blood
  • Lymphoma, Follicular* / complications
  • Lymphoma, Follicular* / diagnosis
  • Lymphoma, Follicular* / physiopathology
  • Neoplasm Staging
  • Parathyroid Hormone / blood
  • Parathyroid Hormone-Related Protein / blood
  • Parotid Gland / pathology
  • Positron-Emission Tomography / methods
  • Sentinel Lymph Node Biopsy
  • Sodium Chloride / administration & dosage
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Zoledronic Acid

Substances

  • Bone Density Conservation Agents
  • Chemokines
  • Cytokines
  • Diphosphonates
  • Diuretics
  • Imidazoles
  • Parathyroid Hormone
  • Parathyroid Hormone-Related Protein
  • Vitamin D
  • Sodium Chloride
  • 1,25-dihydroxyvitamin D
  • Zoledronic Acid
  • Furosemide
  • Calcitonin