以脑膜肿瘤为表现的多发性骨髓瘤  

Meningeal tumours as an initial presentation of multiple myeloma

作　　者：王建宁[1] 候艳秋[1] 张柳波[1] 宋敏[1] 孟庆奇[1] 包红雨[1] 傅行财[1] 

机构地区：[1]南京医科大学第二附属医院血液科,江苏南京210011

出　　处：《现代肿瘤医学》2012年第4期799-802,共4页Journal of Modern Oncology

摘　　要：目的:探讨伴有中枢神经系统(central nervous system,CNS)累及的多发性骨髓瘤(MM)的临床特征、相关高危因素和治疗。方法:报告1例以多发脑膜肿瘤为首发表现的MM并结合文献进行复习。结果:患者为年轻男性,头痛伴全身骨痛,贫血、血小板减少,伴有高钙血症和肾功能异常,头颅MRI示多发脑膜肿瘤,胸部CT示胸膜不规则增厚,骨髓象以原浆细胞为主,脑脊液涂片可见浆细胞,血清IgG水平明显增高,轻链测定κ链明显异常,免疫固定电泳示IgG和κ链条带阳性,染色体检查示复杂核型和数量异常,患者生存期不足1月。结论:MM伴CNS浸润少见,其高危相关因素包括染色体异常、原浆细胞形态和伴有其他髓外病变。有效的治疗方法尚不明确,预后较差。治疗可采取鞘注药物、全身化疗和颅脑放疗以及造血干细胞移植,所有的治疗方案应包括颅脑放疗。Objective：To explore the clinical features,unfavorable factors and treatment of multiple myeloma invasion of the central nervous system.Methods： One case with multiple meningeal tumours as an initial presentation of multiple myeloma was reported and the related articles were reviewed.Results： A 29-years-old man hospitalized for headache and bone pain.Laboratory findings on diagnosis were： anemia,thrombocytopenia,hypercalcemia and impaired renal function.He was found to have the multiple meningeal tumours by MRI scan of brain and irregular pleura thickening by CT scan.Meanwhile,the patient had other characteristics： plasmablastic morphology in the bone marrow,plasma cells in the cerebrospinal fluid,high concentration of serum IgG and κ chain,positive of the monoclonal IgG band and κ chain band in the immuno-elecrophorese,complex structural and numerical abnormalities in the cytogenetic analysis of the marrow.His survival was less than 1 month.Conclusion： Invasion of the central nervous system in multiple myeloma is considered extremely rare and strongly associated with unfavorable chromosomal abnormalitiea,plasmablastic morphology and additional extramedullary disease.The most effective treatment schedule for this disorder remains unknown and is associated with a poor prognosis.Treatment options include intrathecal chemotherapy,system chemotherapy,cranial irradiation or a combination,and hematopoietic stem cell transplantation.Cranial irradiation should be included in any treatment modality.

关 键 词：多发性骨髓瘤 中枢神经系统骨髓瘤 治疗 

分 类 号：R733.3[医药卫生—肿瘤]