Two Autopsy Cases of Reticulosarcoma Associated with Hypercalcemia.

MATSUMOTO Noboru, OYAMA Hideki, SUETSUGU Nobumasa, MATSUMURA Shigeichi, NAKASHIMA Koji, KOBAYASHI Katsumasa, SATO Tomoki, KAGEOKA Takeshi, ODA Susumu, ODA Etsuko, MIWA Shiro, ISHIHARA Tokuhiro

doi:10.11406/rinketsu.14.164

Two autopsy cases of reticulosarcoma complicated with hypercalcemia at the terminal stage were reported and the mechanism of hypercalcemia in malgnant diseases was discussed. The main cause of hypercalcemia in these two cases should be ascribed to rapid bone destruction by tumor cells.<br>Case 1. A 40-year-old male was admitted because of painful swelling of the lymph nodes in April, 1971. A biopsy of the inguinal node indicated involvement of reticulum cell sarcoma. The lymphadenopathy regressed after combination chemotherapy and irradiation, but reappeared one month later with leukemic blood picture and disseminated skin infiltration. The serum calcium level at the terminal stage was more than 8 mEq/L, serum phosphorous 2.1 mEq/L and urea nitrogen 50 mEq/dl. He vomitted frequently and became increasingly comatous and died in hypercalcemic state at the end of June. Postmortem examination revealed marked infiltration of tumor cells in the bone marrow with resultant destruction of the bone trabeculae. Metastatic calcification was demonsteated in the lung, liver, kidney and gastric mucosa. The parathyroid glands showed questionable hyperplasia of the chief cells.<br>Case 2. A diagnosis of malignant lymphoma was made on this 57-year-old man by bone marrow aspiration, who was transferred to our ward because of progressive hepatomegaly in April, 1971. On admission the patient was somnolent and disorientated. The liver was felt 5 finger breadth and enlargement of the lymph nodes was noted at the axillary and inguinal regions. The serum calcium level was 8.1 mEq/L and the phosphorous 2.9 mEq/L. Hyper calcemia was overlooked and no treatment other than antibiotics was given because of marked deterioration of his general condition. He became progressively comatous and anuria developed two weeks later. At the terminal of fresh stage, the serum calcium level dropped to 4.3 mEq/L, but on the other hand serum phosphorous was 6.7 mEq/L and urea nitrogen rose to 196 mg/dl. The patient died from renal failure on the 17th hospital day. Autopsy disclosed infiltration of reticulosarcoma in the various organs including severe marrow involvement. In the sternum, many foci of fresh ischemic infarction were noted and demineralization of the bone trabeculae was confirmed histologically. Metastatic calcification was noted in the kidney, liver and lung. The parathyroid glands revealed clear cell hyperplasia, but the laboratory data did not support their hyperfunction.

Two Autopsy Cases of Reticulosarcoma Associated with Hypercalcemia.

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