多发性骨髓瘤伴肺内浆细胞瘤1例

患者 ,男 ,70岁。因浮肿、尿少伴头晕、乏力半个月于 2 0 0 0年 3月 2 4日入院。半个月前双下肢浮肿 ,尿量减少 ,每日约 80 0～ 1 0 0 0 ml,伴头晕、乏力、食欲减退 ,并逐渐加剧 ,曾在当地卫生院对症治疗 ,无好转。体格检查 :中度贫血貌 ,巩膜无黄染 ,全身浅表淋巴结无肿大 ,皮肤未见皮疹及出血点。桶状胸 ,两肺呼吸音低 ,肺底可闻及湿音 ,心率 1 0 0次 /min,律齐 ,未闻及杂音。腹部检查无特殊。四肢关节无肿大 ,无活动障碍。双下肢明显凹陷性浮肿。实验室检查 :Hb88g/L,WBC1 .9× 1 0 6/L,尿蛋白定性 ( ) ,血清总蛋白 80 .8g/L,白蛋…     

多发性骨髓瘤并双侧卵巢浆细胞瘤1例

多发性骨髓瘤(multiple myeloma,MM)是浆细胞的恶性肿瘤,骨髓瘤细胞在骨髓内克隆性增殖,引起溶骨性破坏,骨髓外肿瘤细胞形成实体肿瘤组织较少见,本文报道1例MM并发卵巢浆细胞瘤。患者女,39岁,2011年1月因劳累后出现腰痛、左下肢疼痛,行CT检查提示腰椎间盘突出,经对症治疗后症状缓解不明显。2011年2月无明显诱因     

孤立性骨髓瘤发展为多发性骨髓瘤1例

孤立性骨髓瘤发展为多发性骨髓瘤１例上海市第一人民医院颜式可，周柱，蔡竟惠关键词骨髓瘤．孤立性，骨髓瘤．多发性，病例报告１病例介绍患者，男，３６岁。１９８３年６月起跨骑自行车时左膝部疼痛不适，无红肿，此后症状渐加重，疼痛延至左大腿外侧和左侧臀部。外院给...     

多发孤立性浆细胞瘤伴维生素D缺乏

多发孤立性浆细胞瘤(MSP)发病率低,相关报道罕见。本文报道1例63岁女性患者,右下肢针刺样疼痛2月余,伴麻木、乏力。实验室检查提示高甲状旁腺激素血症,血清骨源性碱性磷酸酶升高,维生素D缺乏。神经肌电图显示右下肢神经源性损害。骶椎、骨盆CT增强提示骶1椎体右侧见软组织团片灶,呈膨胀性骨质破坏,骨皮质破裂。18 F-FDF PET/CT显示胸骨、胸、腰椎椎体、左侧髂骨及右侧骶骨骨质破坏影。CT引导下经皮穿刺活检免疫组化显示浆细胞骨髓瘤、CD138(+)、MUM-1(+)、Lambda(+)。结合骨髓涂片等结果该病例诊断为多发孤立性浆细胞瘤。     

孤立性骨髓瘤1例

孤立性骨髓瘤１例广西柳州市人民医院血液科叶红，黄永光关键词骨髓瘤．孤立性，病例报告患者，女２８岁，农民，左肩部疼痛、活动障碍４个月，于１９９３年４月９日入院。１９９２年１２月开始出现左肩部隐痛，逐渐出现左上肢活动障碍，无发热及喂寒，无骨痛。门诊拟诊＂...     

直肠孤立性髓外浆细胞瘤及文献回顾

孤立性髓外浆细胞瘤（solitary extramedullary plasmacytoma，SEP）由Schridde在1905年首先报道，临床上非常少见。多发生于淋巴组织较丰富的头颈部。而在直肠的SEP极为罕见。我院1995年2月至2005年10月共收治4例直肠SEP，结合文献回顾，探讨直肠SEP的临床特点、诊断和治疗。     

来那度胺联合小剂量地塞米松治疗肝浆细胞瘤

目的 肝浆细胞瘤临床罕见,其治疗方案报道较少,通过报道1例多发性骨髓瘤疾病进展发生肝浆细胞瘤患者,以提高对多发性骨髓瘤合并肝浆细胞瘤的认识,探讨对本病有效的治疗方案。方法 报道1例来那度胺联合小剂量地塞米松(Rd)治疗多发性骨髓瘤合并肝浆细胞瘤患者,并进行文献复习。结果 本例患者在多发性骨髓瘤基础上伴发肝浆细胞瘤,经Rd化疗后肝浆细胞瘤较前明显缩小,疾病得到有效控制。结论 Rd是治疗肝浆细胞瘤的有效方案。     

颅骨孤立性浆细胞瘤1例报告

患者女,61岁,因半年前开始出现左顶部头皮不适、麻木感,进而出现进展性头皮针刺样疼痛（触软、压之可凹陷）,于2013年6月来我院就诊。查体：左颞顶部局限性肿物,约6cm×7cm大小,质软,皮温增高,皮色正常,无搏动感,活动度差。外院MRI检查示左侧颞顶部占位性病变,考虑脑膜瘤。人我院后行常规及增强CT检查,示左侧颞顶部肿瘤,颅骨侵蚀。     

以胸腔积液为首发症状的多发性骨髓瘤1例并文献复习

目的 提高对多发性骨髓瘤(MM)诊断的认识.方法 报道1例以胸腔积液就诊的MM病例,并对相关文献进行复习.结果 45岁女性,胸闷、憋气3个月.近1个月有少尿及头痛、头晕症状.胸部CT示右侧液气胸,左侧大量胸腔积液,胸壁见扁丘状软组织影突出.胸腔镜下见胸腔内大量淡黄色液体,脏层胸膜和膈胸膜光滑,壁层胸膜大量大小不一的结节,质硬,活检不易出血的.病理示浆细胞瘤.胸骨穿刺骨髓象检查示大量的浆细胞瘤细胞骨髓浸润.结论 MM患者以髓外病变就诊时,应结合临床表现考虑到MM的可能,及时行骨髓检查明确诊断.并发髓外病变时预后不良.     

Solitary Plasmacytoma in the Setting of Langerhans Cell Histiocytosis

Langerhans cell histiocytosis (LCH) is an intriguing disorder characterized by the accumulation of specialized dendritic cells called Langerhans cells in several diverse tissues and body sites. It has been cited in numerous case reports to be associated with a wide variety of malignant neoplasms. Although many hypotheses have been suggested, the basis for such associations remains essentially unknown. We describe another association here that to our knowledge has not been reported thus far: a solitary plasmacytoma occurring at a site of previous involvement by LCH. This constitutes a new addition to the now fairly lengthy list of malignant neoplasms that have been reported to occur in the setting of LCH. The possible reasons for such an association are discussed along with a brief review of LCH.     

Multiple Myeloma in Post Nuclear Accident Crisis

The problem of 2011 nuclear accident crisis draws attention of physicians and medical scientists around the world. The cancer induction is an important adverse effect of exposure to radionuclide. In this specific article, the multiple myeloma, an important hematological cancer, in the post nuclear accident crisis will be discussed.     

Apoptotic Signaling in Multiple Myeloma: Therapeutic Implications

Fifteen thousand new cases of multiple myeloma (MM) will occur in the United States in 2003, and the disease remains incurable. Diverse classes of chemotherapeutic agents induce cell death or apoptosis in MM cells; however, prolonged drug exposures ultimately induce chemoresistance. The mechanisms whereby MM cells resist drugs include alterations in intracellular signaling as well as adherence and cytokines in the bone marrow (BM) microenvironment. Novel agents that target the MM cell in its BM microenvironment are needed to both enhance anti-MM activity and prevent development of drug resistance. Delineation of cellular growth and apoptotic signaling pathways in MM cells may identify molecules that serve as novel therapeutic targets on the basis of interruption of MM cell growth or triggering of MM cell death.     

Sellar Solitary Plasmacytoma Progressing to Multiple Myeloma: A Case Report and Literature Review

Sellar plasmacytoma is a rare cause of sellar lesions. Preoperative diagnosis remains a challenge.We present a 34-year-old Chinese woman with a 25-day history of headache and diplopia. A physical examination revealed incomplete left abducens nerve palsy.The initial diagnosis was invasive pituitary adenoma. The patient’s condition deteriorated suddenly the day before the arranged operating date, with the hemoglobin level declining from 113 to 70 g/L. The operation was cancelled and further studies confirmed the diagnosis of sellar solitary plasmacytoma that progressed to multiple myeloma. After undergoing radiotherapy, high-dose chemotherapy, and autologous peripheral blood stem cell transplantation, complete remission was achieved on 4 years follow-up.We reviewed the pertinent literature and reached the following conclusions: sellar plasmacytomas with development of multiple myeloma on follow-up more likely happened in men than in women; and if the sellar plasmacytoma does not compress the cranial nerve, transsphenoidal resection should be cautious because the systemic treatment with radiotherapy, chemotherapy, and autologous peripheral blood stem cell transplantation may be more effective with little invasion.     

Diffuse Pulmonary Parenchymal Involvement in Multiple Myeloma: Antemortem Diagnosis

Antemortem diagnosis of diffuse myelomatous pulmonary infiltrate is rare. We present one such case in which diagnosis was established from bronchoalveolar lavage (BAL) fluid demonstrating the presence of monoclonal plasma cells. The diffuse involvement of the lungs by myeloma was confirmed at autopsy. The possibility of myelomatous pulmonary infiltrates was suggested by the absence of fever or failure to respond to antibiotics but regression with myeloma treatment. Analysis of BAL fluid for the presence of plasma cells and for cytoplasmic immunoglobulin DNA provides a noninvasive means of establishing the diagnosis. Diffuse parenchymal lesions in the lung due to myeloma should be entertained as a differential of pulmonary infiltrates.     

Thalidomide in the Management of Multiple Myeloma

The discovery that multiple myeloma is associated with new vessel formation and is correlated with survival and proliferation led initially to the use of thalidomide for patients with relapsed or refractory disease. The outcome with conventional chemotherapy in this setting has historically been very poor. New insights into the biology of the disease suggests that thalidomide may work via a number of other mechanisms and the advent of the thalidomide analogues with their differential effects on survival and proliferation pathways has opened up a new era in the understanding and treatment of the disease. The encouraging results from phase I/II trials of these agents has meant that for the first time in 50 years there is the opportunity to improve outcome. Further work is in progress to define how best to use these drugs and their role in treatment at different stages of the disease.     

Plasmacytoma: An Unusual Cause of a Pituitary Mass Lesion. A Case Report and a Review of the Literature

A sixty six year old female presented with headache and decreased hearing. Clinical examination confirmed the presence of impaired hearing on the left side. Visual fields were full to confrontation and corrected visual acuity was normal. CT scan of brain revealed a pituitary mass. Preoperative anterior pituitary function was normal. Transsphenoidal decompression was performed, and histology was that of a plasmacytoma. Post operative pituitary function was normal. The patient had no symptoms or signs of multiple myeloma and subsequent investigations revealed no evidence of the disease. One year after diagnosis a course of radiotherapy was administered for local tumour recurrence. During seven years of follow-up, no evidence of multiple myeloma has emerged. Only thirteen similar cases have been described. Four of these had evidence of multiple myeloma at presentation and six progressed to it during follow-up. In twelve patients cranial nerve deficits were recorded. In any cases where it was documented, preoperative anterior pituitary function was normal. In a number of cases histology was reported initially as being that of a non-functioning adenoma, the true diagnosis being discovered, either by electron microscopy findings or after the development of multiple myeloma. Plasma cell tumours of the pituitary area are rare and can present with symptoms and signs indistinguishable from non-functioning adenoma. Atypical symptoms such as cranial nerve involvement or unexpected preservation of anterior pituitary function should arouse suspicion.     

Recent Developments in Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Multiple myeloma (MM) is often successfully controlled with conventional chemotherapy; however, complete remissions are uncommon, and cure is rare. High-dose therapy followed by administration of autologous or allogeneic stem cells, used for the treatment of MM in the past 15 years, is promising as a means of increasing remission rates and improving survival. Autologous transplantation has not always demonstrated survival benefits in randomized studies because most of the patients receiving transplants have relapses, whereas patients given conventional therapy can receive salvage transplants when relapse occurs. Efforts to improve the results of autologous transplantation include targeted radiation, tandem transplantation, and posttransplantation immunotherapy. Only allogeneic hematopoietic stem cell transplantation is potentially curative, owing to a graft-versus-myeloma effect. Although patients who receive either allogeneic or autologous stem cell transplants for MM have similar 3- to 5-year survival rates, only allograft recipients appear to enjoy long-term disease-free survival. High transplantation-related mortality associated with allogeneic stem cell transplantation is currently the major limitation to wider use of this potentially curative modality. Strategies designed to improve the therapeutic index of allografts include the use of nonablative conditioning regimens, peripheral blood cells rather than bone marrow, graft engineering, and targeted conditioning therapies, such as bone-seeking radioisotopes.