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題 名 | Multiple Myeloma Presenting with a Paraspinal Tumor and Malignant Effusion: Case Report=多發性骨髓瘤以脊椎旁腫瘤與惡性肋膜積液來表現 |
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作 者 | 楊禮瑜; 吳沼漧; 王瑞隆; 郭景元; 邢福柳; | 書刊名 | 長庚醫學 |
卷 期 | 22:2 1999.06[民88.06] |
頁 次 | 頁293-298 |
分類號 | 416.66 |
關鍵詞 | 多發性骨髓瘤; 肋膜積液; 脊椎旁腫瘤; 高血黏性症候群; Multiple myeloma; Pleural effusion; Paraspinal tumor; Hyperviscosity syndrome; |
語 文 | 英文(English) |
中文摘要 | 多發性骨髓瘤源於漿細胞的惡性增殖,主要侵犯骨髓,但髓外器官亦會遭受波及 。而造成惡性肋膜積液的情況則極為罕見。本篇將報告一例單株免疫球蛋白 IgG- λ成分的 多發性骨髓瘤,臨床上以背痛,脊椎旁腫瘤,與肋膜積液來表現。放射學檢查顯示左側肋膜 積水及脊椎旁腫瘤併肋骨侵蝕。實驗室檢查顯示病人有貧血及血清中球蛋白數值比白蛋白還 高。蛋白質電泳術與免疫電泳術顯示在血液、尿液及肋膜積液中,單株免疫球蛋白 IgG- λ 成分偏高。超音波引導的經皮穿胸腫瘤切片術及肋膜積水抽取術為有效的診斷工具。肋膜積 液內含相當多未成熟的漿細胞。肋膜積液的免疫細胞表型術顯示其為單株的漿細胞,與惡性 肋膜積液相符合。骨髓抽取術與組織切片術證實是漿細胞骨髓瘤。各文獻報告的預後好壞不 一。在我們的案例中以局部放射線治療與 melphalan 及腎上腺皮質類固醇 (prednisolone) 為主要的化學治療,能達到很好的緩解作用。然而在診斷 15 個月後病情惡化。最後仍然併 發高血黏性症候群與敗血症。 |
英文摘要 | We describe a patient with multiple myeloma which presented as a thoracic paraspinal tumor and myelomatous pleural effusion. He had manifested a gradual onset of upper back pain with radiation to the left chest wall for 3 months. A radiographic examination showed left pleural effusion and a paraspinal tumor with rib destruction at the left T5-6 level. Laboratory data showed anemia and a reversed serum albumin to globulin ratio. Protein electrophoresis and immunoelectrophoresis showed a monoclonal IgG- λ chain component in the serum, urine, and pleural effusion fluid. Ultrasound-guided transthoracic mass biopsy and thoracentesis were performed for diagnosis. Biopsy of the thoracic tumor showed a solid mass composed of immature plasma cells. The pleural effusion fluid contained numerous immature plasma cells. An immunophenotype study of the pleural effusion fluid revealed monoclonal plasma cells, compatible with malignant pleural effusion. A specimen of bone marrow was interpreted as typical for plasma cell myeloma. Local radiotherapy and chemotherapy with melphalan and prednisolone resulted in good partial remission with a stable condition. Later, however, the disease flared up and hyperviscosity syndrome developed with epistaxis and retinal hemorrhage. He died of sepsis about 15 months after the initial diagnosis. |
本系統中英文摘要資訊取自各篇刊載內容。