World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Case Report

Volume 14, Number 6, December 2023, pages 570-574

Catch the Calcium: T-Cell Histiocyte-Rich B-Cell Lymphoma Presenting as Hypercalcemia

Figure 1. Bone marrow biopsy with involvement by large B-cell lymphoma. (a) Marrow core biopsy with nodular involvement by lymphoma (right lower corner) and hypercellular for age marrow with trilineage hematopoiesis (left upper corner) (H&E stain, × 100). (b). Lymphoma infiltrate composed predominantly of small lymphoid cells and occasional histiocytes intermixed with scattered large (arrowhead) lymphoid cells (H&E, × 400); Inset: The large cells have irregular nuclei with prominent nucleoli and are surrounded by small lymphocytes (H&E, × 1,000). (c, d) Large lymphoma cells express B-cell markers OCT-2 and CD79a (arrowhead, × 400). (e) Immunohistochemical stain for CD3 highlights numerous small lymphocytes in the lymphoma infiltrate. There is focal rosette formation (arrowhead) of small CD3⁺ T lymphocytes around the scattered large lymphoma cells (× 400). H&E: hematoxylin and eosin; OCT-2: octamer transcription factor-2.

**Table 1.** CMP From the Initial ED Visit, Prior to Beginning R-Mini-CHOP Therapy, After Completing R-Mini-CHOP Therapy, and the Most Recent Results on File
	CMP
^aAbnormal results. These results detail the trends in kidney function, liver function, various electrolytes including calcium, and albumin as it plays a major role in calcium transport. CMP: complete metabolic panel; ED: emergency department; BUN: blood urea nitrogen; Cr: creatinine; GFR: glomerular filtration rate; ALP: alkaline phosphatase; AST: aspartate aminotransferase; ALT: alanine aminotransferase; R-mini-CHOP: decreased doses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with the conventional dose of rituximab (R).
Initial ED visit	95	39^a	1.53^a	43^a	140	4.0	12.7 (13.4)^a	103	3.6	1.99	3.1^a	116	45^a	15
Pre-R-mini-CHOP	92	28^a	1.13	≥ 60	143	4.2	10.0 (10.9)^a	110^a	2.7	2.39	2.9^a	125^a	52^a	16
Post R-mini-CHOP	140^a	47^a	0.93	≥ 60	135^a	5.3^a	8.8 (9.5)	104	2.9	1.91	3.1^a	101	34	62^a
Recent labs	92	18	0.90	≥ 60	140	4.4	9.7 (10.6)	106	4.3	1.68	2.9	123^a	39	37

Table 1. CMP From the Initial ED Visit, Prior to Beginning R-Mini-CHOP Therapy, After Completing R-Mini-CHOP Therapy, and the Most Recent Results on File

CMP

Glucose

BUN

GFR

PO₄

Albumin

ALP

AST

ALT

^aAbnormal results. These results detail the trends in kidney function, liver function, various electrolytes including calcium, and albumin as it plays a major role in calcium transport. CMP: complete metabolic panel; ED: emergency department; BUN: blood urea nitrogen; Cr: creatinine; GFR: glomerular filtration rate; ALP: alkaline phosphatase; AST: aspartate aminotransferase; ALT: alanine aminotransferase; R-mini-CHOP: decreased doses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with the conventional dose of rituximab (R).

Initial ED visit

39^a

1.53^a

43^a

140

4.0

12.7 (13.4)^a

103

3.6

1.99

3.1^a

116

45^a

Pre-R-mini-CHOP

28^a

1.13

≥ 60

143

4.2

10.0 (10.9)^a

110^a

2.7

2.39

2.9^a

125^a

52^a

Post R-mini-CHOP

140^a

47^a

0.93

≥ 60

135^a

5.3^a

8.8 (9.5)

104

2.9

1.91

3.1^a

101

62^a

Recent labs

0.90

≥ 60

140

4.4

9.7 (10.6)

106

4.3

1.68

2.9

123^a

**Table 2.** CBC From the Initial ED Visit, Prior to Beginning R-Mini-CHOP Therapy, After Completing R-Mini-CHOP Therapy, and the Most Recent Results on File
	CBC
^aAbnormal results. These results help to illustrate the overall health of the blood cells and detail the trends in various cell counts including WBC, RBC, and PLT. CBC: complete blood count; WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; HCT: hematocrit; MCHCL: mean corpuscular hemoglobin concentration; MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin; RDW: red cell distribution width; PLT: platelet; ED: emergency department; R-mini-CHOP: decreased doses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with the conventional dose of rituximab (R).
Initial ED visit	3.0^a	2.29^a	8.0^a	25.6^a	111.8^a	34.9	31.3	17.4^a	52^a
Pre-R-mini-CHOP	2.1^a	2.44^a	8.3^a	25.4^a	104.1^a	34.0	32.7	19.2^a	51^a
Post R-mini-CHOP	9.1	2.98^a	9.6^a	29.5^a	99.0	32.2	32.5	22.3^a	80^a
Recent labs	5.7	3.29^a	10.7^a	31.4^a	95.4	32.5	34.1	18.2^a	84^a

Table 2. CBC From the Initial ED Visit, Prior to Beginning R-Mini-CHOP Therapy, After Completing R-Mini-CHOP Therapy, and the Most Recent Results on File

CBC

WBC

RBC

HCT

MCV

MCH

MCHC

RDW

PLT

^aAbnormal results. These results help to illustrate the overall health of the blood cells and detail the trends in various cell counts including WBC, RBC, and PLT. CBC: complete blood count; WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; HCT: hematocrit; MCHCL: mean corpuscular hemoglobin concentration; MCV: mean corpuscular volume; MCH: mean corpuscular hemoglobin; RDW: red cell distribution width; PLT: platelet; ED: emergency department; R-mini-CHOP: decreased doses of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) with the conventional dose of rituximab (R).

Initial ED visit

3.0^a

2.29^a

8.0^a

25.6^a

111.8^a

34.9

31.3

17.4^a

52^a

Pre-R-mini-CHOP

2.1^a

2.44^a

8.3^a

25.4^a

104.1^a

34.0

32.7

19.2^a

51^a

Post R-mini-CHOP

9.1

2.98^a

9.6^a

29.5^a

99.0

32.2

32.5

22.3^a

80^a

Recent labs

5.7

3.29^a

10.7^a

31.4^a

95.4

32.5

34.1

18.2^a

84^a