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作者报道自1980～1994年间34例Richter’s综合征(RS)和304例低度恶性淋巴瘤中4例RS合并高钙血症。 例1.华氏巨球蛋白血症(WM),男,65岁。采用瘤可宁治疗,血清钙正常。4年半后因弥漫性骨痛再次入院。血清钙3.27mmol/L(正常2.06～2.5mmol/L),骨髓活检为弥漫型免疫母细胞淋巴瘤。而诊断为RS。骨放射图示弥漫性骨质缺乏,无局部溶骨性损害。经抗新生物化疗后一度完全缓解(CR),但高钙血症无减轻。 例2.混合性滤胞性淋巴瘤,男,60岁。血清钙正常,经化疗后一度CR。4年后复发,胸部摄片示纵膈淋巴结肿大。血清钙4.94mmol/L。骨髓活检示弥漫型免疫母细胞淋巴瘤。血清钙化醇(Calcitriol)低于正常值。血清TNF-α(正常值0～12pg/ml)和IL-6(正常值6～30pg/ml)分别为25pg/ml和38pg/ml。经水化、降钙素、Pamidronate,血清钙迅速减低。2个月后死于败血症休克,血清钙正常。 例3.B细胞慢淋自血病,女性,73岁。经化疗获部分缓解。血清钙正常。1年后复发。骨放射学图像示
The authors report 4 RS hypercalcemia in 34 cases of Richter’s syndrome (RS) and 304 low-grade lymphomas from 1980 to 1994. Example 1. Fahrenheit macroglobulinemia (WM), male, 65 years old. The tumor can be used for treatment, serum calcium is normal. After 4 and a half years, she was admitted to hospital again because of diffuse bone pain. Serum calcium 3.27mmol/L (normal 2.06 ~ 2.5mmol/L), bone marrow biopsy is diffuse immunoblastic lymphoma. The diagnosis is RS. Bone radiation shows diffuse bone deficiency without local osteolytic lesions. After a complete remission of anti-neoplastic chemotherapy (CR), but no reduction in hypercalcemia. Example 2. Mixed-filtering lymphoma, male, 60 years old. Serum calcium was normal and CR was given after chemotherapy. After 4 years of recurrence, the chest radiograph showed mediastinal lymph node enlargement. Serum calcium 4.94 mmol/L. Bone marrow biopsy showed diffuse immunoblastic lymphoma. Serum calcitriol is below normal. Serum TNF-α (normal 0-12 pg/ml) and IL-6 (normal 6-30 pg/ml) were 25 pg/ml and 38 pg/ml, respectively. Hydration, calcitonin, Pamidronate, serum calcium rapidly reduced. Two months later died of septic shock with normal serum calcium. Example 3. B cell chronic lymphocytic disease, female, 73 years old. Some relief was achieved by chemotherapy. Serum calcium is normal. Recurrence after 1 year. Bone radiology images