多发性骨髓瘤伴中枢神经系统浸润1例并文献复习

目的 探讨多发性骨髓瘤(MM)患者并发中枢神经系统(CNS)浸润的临床特点,提高对该病的认识.方法 收集1例MM伴中枢神经系统浸润患者的临床资料,并结合文献进行分析和总结.结果 65岁女性患者,1年半前行血常规、生化、免疫固定电泳、颈胸椎CT、骨髓细胞学等检查确诊为MM.予以两个疗程化疗后达完全缓解,巩固治疗两个疗程后出现复发,再次予化疗后出现头晕、视物旋转等神经系统症状,完善磁共振成像(MRI)检查示颅内占位性病变,性质不能明确.经多学科会诊考虑腰椎穿刺术有诱发脑疝的巨大风险,患者无手术禁忌,行颅内肿块切除和病理活检确认为浆细胞性肿瘤,明确诊断为MM伴中枢神经系统浸润.术后予以辅助全身化疗,疗效不佳,确诊骨髓瘤侵犯中枢4个月后死亡.结论 MM伴中枢神经系统浸润临床表现多样,对于存在高危因素并出现神经系统症状的MM患者,应警惕MM侵犯中枢神经系统的可能.

One case of multiple myeloma with central nervous system infiltration and literature review

Objective To explore the clinical characteristics of multiple myeloma with central nervous system infiltration and to improve the understanding of the disease.Methods The clinical data of one case diagnosed as multiple myeloma with central nervous system infiltration were selected and analyzed by the relevant literature.Results The female patient was 65 years old,diagnosed with multiple myeloma through the tests of blood routine,biochemistry,immunofixation electrophoresis,thoracic vertebra CT and bone marrow hemocytology a year and a half ago.The patient achieved complete remission after two courses of chemotherapy,yet relapsed after two courses of consolidation therapy,and felt dizziness and visual rotation when the additional chemotherapy was over.The result of MRI revealed intracranial lesions whose character was not clear.The multidisciplinary consultation considered the huge risk of cerebral hernia induced by lumbar puncture.The patient had no surgical contraindications,so the intracranial lesions were resected,and the pathological results indicated plasma cell tumor.Therefore,the patient was diagnosed as multiple myeloma with central nervous system infiltration.Adjuvant systemic chemotherapy was employed after operation,which had poor efficacy,and the patient died after four months when myeloma invaded the central nervous system.Conclusions The clinical manifestations of multiple myeloma with central nervous system infiltration varied,for the MM patients with high risks and emergence of neurological symptoms,the possibility of MM invading the central nervous system should be considered.