[Extranodal non-Hodgkin's lymphoma associated with systemic bone metastasis and secondary myelofibrosis].
A 68-year-old woman was admitted in March 1997 because of lumbago, fever, vomiting, and general malaise. Laboratory data disclosed anemia and severe hypercalcemia (7.7 mEq/l). Multiple osteolytic lesions were detected in the patient's vertebra, pelvis, and bilateral tibia by x-ray films and 99mTc bone scintigrams. Bone marrow aspiration sample was not obtained due to dry tap. Marked myelofibrosis and proliferation of lymphoid cells were revealed by a bone marrow biopsy specimen. Immunohistochemical analysis showed that cells in the biopsy specimen were positive for L-26 and LCA, but not for UCHL-1. Gastrointestinal endoscopic examination found multiple polypoid lesions in the stomach; biopsy specimens of the lesion tissue disclosed invasion by B lymphoid cells. A diagnosis of diffuse large B cell lymphoma was thus made. THP-COP chemotherapy was performed, but only minimal response was obtained. Lymphoma cells subsequently invaded the brain stem, and the patient eventually died of respiratory failure.
First Department of Internal Medicine, Sapporo Medical University School of Medicine.
K
K
Kasahara
T
T
Takahashi
T
T
Oka
M
M
Yamamoto
T
T
Sirata
M
M
Idogawa
M
M
Naeshiro
T
T
Hayashi
M
M
Adachi
Y
Y
Hinoda
K
K
Imai
D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000473:pathology*; D009361:Neoplasm Invasiveness; D055728:Primary Myelofibrosis / Q000209:etiology*; D013274:Stomach Neoplasms / Q000473:pathology