PMC9449614_01
Computed tomography of the body on admission. A well-defined nodule was detected in the middle lobe of the right lung (a), masses with osteolytic changes were observed on the left 5th and right 6th and 7th ribs (b, c), and a soft tissue mass was found along the pericardium (d).
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Pathological findings of the mass lesion on the left 5th rib. Hematoxylin and Eosin staining revealed diffuse atypical lymphocytes with nuclei of different sizes (a, b). Large lymphocytes were positive for CD20 (c) and Ki67 (d).
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Hematoxylin & eosin staining of the biopsy sample revealed diffuse atypical lymphocytes with nuclei of different sizes (Fig. 2a, b), and the immunostaining of samples revealed positive cells for CD20 and Ki67 in a large number of these lymphocytes (Fig. 2c, d).
Immunostaining with the antibody against CYP27B1 (1alpha-hydroxylase) in the biopsy sample (a) and in normal proximal tubule tissue as the positive control (b).
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The results obtained confirmed that lymphoma cells in the tissue sample were positive for CYP27B1 (Fig. 3a), indicating that 1alpha-hydroxylase was ectopically expressed in the lesion.
Clinical course of the patient.
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To treat the patient's hypercalcemia, 2,000 mL/day of saline, 40 units of elcatonin twice a day, and 4 mg of zoledronic acid were administered on the first day (Fig. 4). Consistent with these changes, the value for 1,25(OH)2VitD decreased from 88.2 to 38.8 pg/mL before and 8 days after the administration of steroids, respectively (Fig. 4).