Hypercalcemia With Disseminated Osteolytic Lesions: A Rare Presentation of Adulthood Acute Lymphoblastic Leukemia

Abstract

Osteolytic bone lesions and hypercalcemia without peripheral blasts B-cell acute lymphoblastic leukemia (B-ALL) are reported in children but rarely seen in adults. Herein, we described two patients with B-ALL presenting with hypercalcemia and symptomatic osteolytic bone lesions. They were treated by standard induction chemotherapy after correction of hypercalcemia with supportive measures. With this two case reports we would like to emphasize the importance of clinical awareness of hypercalcemia and osteolytic bone lesions as rare presentations of ALL. The prognostic implication of bone lesions and hypercalcemia in ALL is unclear and needs to be verified in large prospective studies. However, immediate recognition and treatment of hypercalcemia and the underlying B-ALL are vital since a delay of diagnosis poses a possible life-threatening risk.

Case report: BCR-ABL-positive acute lymphoblastic leukemia with bone destruction: a treatment dilemma

“…More than 20% of children with ALL have bone pain at the onset, higher than that in adults with ALL. However, multiple bone destruction is rare in both children and adults with ALL ( 4 , 9 , 10 ). Among adult malignant tumors, multiple bone destruction incidence is 27%–35% in lung cancer, 25%–30% in breast cancer, 7%–30% in multiple myeloma, < 10% in malignant lymphoma, and < 1% in leukemia ( 2 ).…”

Hypercalcemia and Lytic Bone Lesions As a Rare Presentation of Acute Lymphoblastic Leukemia: A Case Report

“…Skeletal manifestations are rare presenting features in adult patients with ALL [4]. The mechanisms leading to the lytic lesions in ALL remain uncertain [5]. Two general mechanisms explain malignancy-associated hypercalcemia, osteolytic lesions due to the direct invasion of the skeleton by tumor cells and the ectopic production of circulating factors that activate osteoclastic bone resorption.…”

Hypercalcemia (C), renal dysfunction (R), anemia (A), and lytic bone lesion (B) (CRAB) as presenting features in non myelomatous malignancies: A case report and review of the literature

“…CRAB like initial presentation mimicking active myeloma is uncommonly reported in the literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] In this manuscript we describe a middle-aged female subject who presented with clinicoradiological and biochemical features secondary to metastatic breast cancer mimicking CRAB positive myeloma and present a comprehensive review of all such CRAB positive nonmyelomatous malignancies reported in the literature.…”

“…There were twenty-two cases of CRAB positive nonmyelomatous malignancies (M:F = 1:1) the details of which are briefly summarized in Table 1. [3][4][5][6][7][8][9][10][11][12][13][14][15][16] The median age at presentation was 58. G reversal was described in a case reported by Roy et al in a case of primary osseous Burkitt lymphoma.…”