Hypercalcemia in Patients with Malignant Lymphoma

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Abstract
The clinical, roentgenographic and post-mortem findings of 29 patients with malignant lymphoma who had skeletal involvement by tumor and/or hypercalcemia has been reviewed. Eight of these patients had significant hypercalcemia. In all but two of these, bone involvement could be proven at post-mortem examination. Lack of evidence of tumorous bone involvement in one of the latter two patients was due to the fact that portions of the skeleton which were seen to be involved by tumor on roentgenograms were not examined at post-mortem examination. The patients with hypercalcemia had a tendency to have lower serum phosphorus and alkaline phosphatase levels than the normocalcemic group. One of the patients with Hodgkin''s disease with a slightly higher than normal serum calcium level had a marked increase in renal clearance of phosphorus similar to patients with hyperparathyroidism. This increased renal clearance of phosphorus and the lack of evidence of tumorous bone involvement in another hypercalcemic patient may be indicative of a humoral factor in the etiology of hypercalcemia in neoplastic disease. The relatively low levels of alkaline phosphatase in the presence of hypercalcemia are probably indicative of decreased osteoblastic activity during active bone breakdown in the hypercalcemic state.

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