Primary ovarian lymphoma manifesting with severe hypercalcemia

To describe a case of primary ovarian lymphoma manifesting with severe hypercalcemia.

We report the occurrence of a substantially increased serum calcium level in a 74-year-old female patient who presented with progressive weakness, volume depletion, confusion, slurred speech, cardiac abnormalities, and renal insufficiency. The patient's clinical course is reviewed, and the results of laboratory and imaging studies leading to the underlying diagnosis are presented.

Initial evaluation revealed hemodynamic instability, disorientation, cardiac rhythm abnormalities, high levels of blood urea nitrogen and creatinine, and a serum calcium level of 18 mg/dL. A cranial computed tomographic scan showed no evidence of pronounced atrophy or stroke. Aggressive rehydration was initiated, and a permanent pacemaker was inserted. A suppressed level of parathyroid hormone and a high serum 1,25-dihy-droxyvitamin D concentration were found, but no evidence of granulomatous disease, infection, or overt malignant lesion was detected. The patient showed clinical improvement and was dismissed from the hospital, but the hypercalcemic state recurred soon thereafter. A computed tomographic scan of the abdomen and pelvis revealed a pelvic mass, which was diagnosed as ovarian lymphoma after surgical removal. The serum calcium and 1,25-dihy-droxyvitamin D levels normalized postoperatively.

Primary ovarian lymphoma can be a cause of, and can manifest solely as, a severe and symptomatic increase in the serum calcium level, which is mediated by an increased serum concentration of 1,25-dihy-droxyvitamin D. It should be considered in the differential diagnosis of unexplained nonparathyroid hypercalcemia.