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Primary Colonic Lymphoma With Paraneoplastic Hypercalcemia.

Thomas Augustine¹, Abhilash Perisetti², Salman Ali Khan²

¹Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.

ACG Case Reports Journal

|September 28, 2020

Summary

This case report details a rare instance of primary colonic lymphoma presenting as hypercalcemia and an abdominal mass. The diagnosis was confirmed as diffuse large B-cell lymphoma, highlighting a critical paraneoplastic syndrome.

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Area of Science:

Gastroenterology
Oncology
Pathology

Background:

Primary colonic lymphoma is an exceptionally rare malignancy, comprising a small fraction of all colorectal cancers.
This report focuses on a unique case presentation of this rare condition.

Observation:

A 63-year-old male presented with altered mental status secondary to hypercalcemia.
Physical examination revealed a palpable abdominal mass on the right side.
Imaging studies identified a colonic mass, subsequently diagnosed as diffuse large B-cell lymphoma via colonoscopy and biopsy.

Findings:

The diagnosis of primary colonic lymphoma was established using the Dawson criteria, excluding extracolonic disease.
Elevated calcitriol levels were identified, indicating a paraneoplastic manifestation of the lymphoma.

Implications:

This case underscores the importance of considering rare gastrointestinal malignancies in the differential diagnosis of hypercalcemia.
It highlights the potential for paraneoplastic syndromes to be the initial presenting feature of colonic lymphoma.
Early recognition and diagnosis are crucial for effective management of primary colonic lymphoma.