hypercaicemic AIL patients. 1. Introduction Adult T-cell leukemia (ATL) was first reported as a new clinical entity in 1977 in Japan [1, 2]. The predominant physical findings are skin involvement, such as erythroderma and nodule formation due to the infiltration of neoplastic cells, lymphadenopathy, and hepatosplenomegaly. The ATL cells are of mature T-helper phenotype and have a characteristic appearance with especially indented or lobulated nuclei. Hypercalcemia is common in patients with ATL, and such patients often show increased numbers of osteoclasts. A type C retrovirus was isolated from patients with cutaneous T-cell lymphoma by Poiesz and colleasues in 1980 [3]. ThisHuman T-cell leukemia virus type-1 (HTLYV-1) is the causative agent of adult T-cell leukemia (ATL). Hypercalcemia is common in patients with ATL. These patients rarely develop metastatic calcification and acute pancreatitis. The underlying pathogenesis of this condition is osteoclast hyperactivity with associated overproduction of parathyroid hormone- related protein, which results in hypercalcemia in association with bone demineralization. The discovery of the osteoclast differentiation factor receptor activator of nuclear factor-«B ligand (RANKL), its receptor RANK, and its decoy receptor osteoprotegerin (OPG), enhanced our understanding of the mechanisms of ATL-associated hypercalcemia. Macrophage inflammatory protein-1-a, tumor necrosis factor-a, interleukin-1, and interleukin-6 are important molecules that enhance the migration and differentiation of osteoclasts and the associated enhanced production ofMaybe | missed that pathology lecture, or maybe | was sleeping when the terms were discussed.A For whatever reason, | have always had a hard time with dystrophic and metastatic calcification.A | could remember that one type of calcification was simply the result of having a high calcium level, but | couldn't really define the terms and keep straight which one was which. If you have had that problem, maybe this will help clear it up once and for all. Dystrophic calcification This type of calcification is seen in areas of necrosis. Some examples of lesions with dystrophic calcification include: atherosclerotic plaques, aging or damaged heart valves, and tuberculous lymph nodes.2. Metastatic Calcification Go to: > The mechanism of calcification in the viscera is categorized into two groups. Metastatic calcification with hypercalcemia occurs when calcium deposits in previously normal tissue whereas dystrophic calcification occurs in previously damaged tissue. (1) Dystrophic calcification in injured or necrotic tissue in a normal serum calcium level, such as tuberculosis, abscess, and hydatid disease. (2) Metastatic calcification can be divided into malignant and nonmalignant causes. Metastatic calcification in malignancy is reported in parathyroid carcinoma, multiple myeloma, lymphoma, leukemia, hypopharyngeal squamous cell carcinoma, synovial sarcoma, breast carcinoma, and3. Acute Pancreatitis with Go to: » Hypercalcemia ATL associated with hypercalcemia and acute pancreatitis was first described in 1984 by Hosokawa et al. [43], followed later by other reports in 1990s [21, 44, 45]. Hypercalcemia is difficult to treat and can be the cause of death in ATL [46, 47]. The relation between hypercalcemia and acute pancreatitis in patients with ATL was suggested based on the observation of pancreatitis in hypercalcemic renal transplant recipients [48]. However, the exact reason linking hypercalcemia and acute pancreatitis in patients with ATL remains to be elucidated. A plausible theory [49] is the following sequence: high serum calcium levels increase calcium levels in pancreatic juice, which result in accelerated calcium-dependent conversion of trypsinogen to trypsin, leading to acute pancreatitis. Another possibility involves the high levels of nephrogenous cyclic adenosine monophosphate [47], whichee Dystrophic vs Metastatic Calcification Dystrophic calcification is f the deposition of calcium salts in dead or degenerated tissues Serum calcium level is normal | Generally irreversible Localized Necrosis, infarct, thrombi, dead parasites, certain tumor or cyst Increased binding of | phosphates with necrotic tissues which in turn bind to calcium and thus | forming calcium phosphate precipitates i Generally better d prognosis due to little septicaemia Metastatic calcification is the deposition of calcium salts in normal Cui Serum calcium level is elevated Reversible upon correction of metabolic disorder Occurs in many tissues throughout the body Hyperparathyroidism. resorption of bone tissue, disorders of vitamin D, renal failure, prolonged immobilization. aluminium intoxication and milk alkali syndrome Increased precipitation of calcium phosphate due to hypercalcemia at otTae Take (ola) lungs, stomach, blood Nioitt 1 ial ket Generally poor prognosis due to profound toxaemia