脊柱孤立性浆细胞瘤的临床病理分析

目的 分析脊柱孤立性浆细胞瘤的临床特征、影像表现、病理诊断与治疗.方法 对13例脊柱孤立性浆细胞瘤作临床、放射和病理观察及随访,免疫组织化学EnVision法行白细胞共同抗原、CD20、CD79a、CD3、CD7、PC、MUM1、CD138、IgG、IgM、CD10、bcl-6、κ、λ、Ki-67染色分析免疫表型.结果 13例脊柱孤立性浆细胞瘤患者年龄42-69岁(平均年龄56岁),男女比例3.3∶1;9例发生于胸椎,4例发生于腰椎.病程从半个月到5年不等,病椎附近疼痛是共同的首发症状.X线多表现为椎体的溶骨性破坏;CT多为椎体骨质虫噬状破坏;MRI椎体信号失均,T1加权低信号,T2加权等或稍高信号,增强扫描有不均匀强化.病理学特征为:肿瘤细胞呈弥漫性浸润;分化成熟的瘤细胞形似正常浆细胞,分化不成熟的瘤细胞形似中心母细胞;世界间质少,血管丰富或形成血湖;淀粉样物质沉积.免疫表型:13例之瘤细胞均表达CU79a,均不表达CD20和CD3、CD7,呈轻链限制性表达;所有病例瘤细胞均表达PC,10例表达MUM1,10例表达CD138,5例表达IgG,1例表达IgM,Ki-67指数为10%-50%.治疗均进行局部手术,术后选择性放疗或化疗.结论 脊柱孤立性浆细胞瘤具有特征性的临床、影像和病理学改变,诊断时应综合考虑,排除多发性骨髓瘤,提倡尽早影像学检查、全身骨扫描,治疗应手术切除局部病灶,选择性放疗及化疗并长期随访.

Solitary plasmacytoma of spine:a clinical, radiologic and pathologic study of 13 cases

Objective To study the clinical, radiologic and pathologic features of solitary plasmacytorna of spine. Methods The clinical, radiologic and pathologic features, as well as treatment and fallow-up data, of 13 solitary plasmacytoma of spine cases were retrieved and analyzed. Immunohistochemical study using EnVision method for LCA, CD19, CD20, CD79a, CD3, CD7, PC,MUM1, CD138, IgG, IgM, kappa, lambda and Ki-67 was carried out. Results All the tumours were primarily located in the vertebrae (including 9 cases in thoracic vertebrae and 4 cases in lumbar vertebrae).years). The commonest symptom was pain in the surrounding regions. The degree of neurologic disturbance mostly depended on the extent of vertebral destruction and structural instability of the spine. Radiologic examination showed mainly osteolytic lesions in vertebrae. Magnetic resonance imaging demonstrated the presence of heterogeneous intensity inside the involved vertebrae (low in T1 weighted and high in T2 weighted images). Histologic examination showed diffuse infiltration by malignant cells. In welldifferentiated plasmacytomas, the tumor cells resembled normal plasma cells.In poorly differentiated examples, the cellular morphology mimicked that of the centroblasts. The interstitial stroma was scanty and contained plenty of vessels, sometimes with formation of blood lakes. Amyloid deposition was present in some of the cases.Immunohistochemical study showed that the tumor cells were positive for CD79a and negative for CD20. Light chain restriction was detected in all the 13 cases studied. Plasma cell marker PC was expressed in all cases, while IgG was positive in 5 cases, IgM in 1 case, MUM1 in 10 cases and CD138 in 8 cases. Ki-67 index varied from 10% to 50%. All cases were operated, with adjuvant chemotherapy and radiotherapy given. Conclusions Correlation of clinical, radiologic and pathologic features is important in diagnosis of solitary plasmacytoma of spine. The possibility of multiple myeloma needs to be excluded. Early detection by radiologic examination, local surgical resection, post-operative chemoradiotherapy and long-term follow-up are prudent for successful management of this condition.