Poorly differentiated lymphocytic lymphoma with ectopic parathormone production: visulization of metastatic calcification by bone scan

Immunohistochemistry in Diagnostic Parathyroid Pathology

Pathologists are usually readily able to diagnose parathyroid tissues and diseases, particularly when they have knowledge of the clinical information, laboratory findings, and radiographic imaging studies. However, the identification of parathyroid tissue or lesions can be difficult in small biopsies, ectopic locations, supranumerary glands, and in some oxyphil/oncocytic lesions. Widely available immunohistochemical studies such as chromogranin-A, synaptophysin, keratin, parathyroid hormone, thyroglobulin, and thyroid transcription factor-1 can help in difficult cases. One of the most difficult diagnostic aspects faced by the pathologist in evaluating parathyroid is distinguishing between parathyroid adenoma, particularly atypical adenoma, and parathyroid carcinoma. Many markers have and continue to be evaluated for diagnostic utility, and are even beginning to be studied for prognostic utility. Single immunohistochemical markers such as parafibromin and Ki-67 are among the most studied and most utilized, but many additional markers have and continue to be evaluated such as galectin-3, PGP9.5, Rb, bcl2, p27, hTERT, mdm2, and APC. Although not widely available in many laboratories, a panel of immunohistochemical markers may prove most useful as an adjunct in the evaluation of challenging parathyroid tumors.

Pulmonary metastatic calcification in a leukemic patient: a case report

Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in children and accounts for 80% to 85% of cases. Hypercalcemia-associated pulmonary calcification has been observed in ALL, but overall it is a rare condition. Hereby, we wanted to report a case of pulmonary metastatic calcification in a 4-year-old girl with diagnosis of ALL in our center, who died 1 year after diagnosis of leukemia. Pulmonary infiltrates were seen 2 months after diagnosis of leukemia, which was proved to be the flecks of calcium in alveolar spaces after open-lung biopsy performed 4 months after diagnosis of ALL, but elevated serum calcium was detected late in the course of the disease (7 mo after lung biopsy), this late occurrence of hypercalcemia is not reported yet.

Hypercalcemia and vitamin D metabolism in Hodgkin's disease. Is there an underlying immunoregulatory relationship?

Hypercalcemia is not common in Hodgkin's disease, but in reported cases is often unassociated with bone involvement. A case is presented demonstrating a mechanism involving elevated levels of 1,25-dihydroxy vitamin D3 (calcitriol). Similar cases in the literature are reviewed. Data implicating calcitriol as a hematolymphoid regulatory hormone are discussed as they may relate to lymphomas, leukemias, and paraneoplastic lymphocyte and monocyte/macrophage activity.

Metastatic visceral calcification identified by bone scanning

The scintigraphic abnormalities with radionuclide bone scanning observed in a patient with metastatic breast carcinoma associated with hypercalcaemia are described. Abnormal uptake of 99mTc-pyrophosphate was noted in the lungs, stomach, myocardium, kidneys, and thyroid, indicating metastatic visceral calcification. A scan performed 72 h later when she was normocalcaemic showed marked reduction in the accumulation in the myocardium and thyroid. In a further scan, 18 months later, no extraosseous uptake was present. A review of 26 reported cases of visceral metastatic calcification with scintigraphic abnormalities indicates that the changes in this patient were more widespread and that in only two of the previous cases similar total resolution had been observed. The reasons for the discrepancy between the incidence of visceral calcification on autopsy and on scintigraphic examination are discussed in relation to the aetiological factors. It is concluded that bone scanning offers a useful method for identifying visceral calcification, except when associated with uncomplicated renal failure, and is valuable in detecting this abnormality in patients with hypercalcaemia and in the assessment of response to therapy.