[An autopsy case of adult T-cell leukemia complicated with metastatic calcification of the lung].
46-year-old male patient was born in Niigata Prefecture and thereafter lived in Tokyo. In late January 1985, he noticed swelling of the bilateral inguinal lymph-nodes followed by fever and lumbago. In February, he consulted a local doctor and hepatosplenomegaly, marked leukocytosis and renal dysfunction were pointed out and he was referred to our hospital on February 22nd. The clinical laboratory data on admission were as follows; WBC 23,200/microliter, serum-Ca 18.4 mg/dl, BUN 85.3 mg/dl, creatinine 5.4 mg/dl, antibody to ATLV x160. ATL was diagnosed by biopsy of lymph nodes and examinations of peripheral blood and bone marrow hemogram. Remission was achieved in March by the treatment with adriacin. Renal failure and hypercalcemia also improved. However his respiratory dysfunction gradually worsened. The chest radiographies++ showed pulmonary edema, although there was no clinical evidence of heart failure. When his condition became stable, TBLB was performed and revealed extensive deposition of calcium along alveolar septae, suggesting that pulmonary edema was induced by the metastatic calcification of the lung. After the second treatment for ATL, he died of pneumonia. The autopsy showed calcium deposition not only in the lung but in pyramids of the kidney and in sub-serous layer of the small intestine. There was no tumor cell invasion into the bone or parathyroid gland. High urinary c-AMP together with normal levels of PTH suggested that the hypercalcemia in this case was induced by PTH-related protein. It was concluded that careful treatment for hypercalcemia is important as regards the occurrence of pulmonary edema.
Sasaki
I
I
First Department of Internal Medicine, School of Medicine, Nihon University.
Morimoto
K
K
Koya
Y
Y
Mutoh
T
T
Hagiwara
T
T
Hosokawa
Y
Y
Yamaguchi
M
M
Sawada
U
U
Horie
T
T
D002114:Calcinosis / Q000209:etiology* / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000473:pathology; D015458:Leukemia, T-Cell / Q000150:complications* / Q000473:pathology; D008168:Lung / Q000473:pathology; D008171:Lung Diseases / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged