宫颈癌后IgE-kappa型多发性骨髓瘤1例并文献复习  

Case report and review of literature: an IgE-kappa multiple myeloma secondary to cervical cancer

作　　者：时明月 张茵[1] 孙恺[1] 陈玉清[1] 牛晓娜[1] 张文荟[1] 

机构地区：[1]郑州大学人民医院,郑州450003

出　　处：《医药论坛杂志》2016年第1期1-3,共3页Journal of Medical Forum

基　　金：河南省2013年科技发展计划(132102310184)

摘　　要：目的探讨宫颈癌后IgE-kappa型多发性骨髓瘤的临床及实验室检查特点,诊断、鉴别诊断、治疗及预后。方法对1例新确诊的宫颈癌后IgE-kappa型骨髓瘤进行回顾,对其临床表现、实验室检查结果及治疗方案进行分析,并结合相关文献复习。结果影像检查结果提示多发骨质破坏,骨髓细胞形态学提示幼稚浆细胞占68.8%,血清蛋白电泳提示在γ球蛋白组份中出现M蛋白,血清免疫固定电泳提示IgE-kappa型M蛋白,确诊为IgE-kappa型多发性骨髓瘤。经4疗程的"BD(硼替佐米+地塞米松)"方案化疗后,临床症状缓解,M蛋白、肌酐等显著下降。结论宫颈癌后多发性骨髓瘤少见,骨髓瘤中IgE型更为罕见,诊断时要注意与骨转移性肿瘤及其他类型骨髓瘤相鉴别,要掌握IgE骨髓瘤的临床及实验室特征,以免漏诊。BD方案作为治疗骨髓瘤的一线方案,在治疗IgE型骨髓瘤中有其优势。Objective To report an unusual case of IgE myeloma occurred secondary to cervical cancer and compare its clinical peculiarities, as well as laboratory characteristics by reviewing the literature. Methods In order to sum up features of this special case of IgE myeloma which presents as a second cancer,we retrospected the patient＇ s clinical manifestations, laboratory detecting results and treatment responses to novel agents during the courses of therapy. Results The patient＇ s PET/CT（ positron - emission tomography/computerized tomography） showed that multiple lesions could be found in cranial and trunk bones, while no sign of cervical cancer had a relapse. In addition, naive plasma cells which accounting for 68.8% of the plasmacyte series could be seen in the bone marrow smear. Monoclonal protein equally appeared at the γ- globulin component by serum protein electrophoresis. Meanwhile, immunofixation electrophoresis revealed IgE and kappa positive bands which finally assisted us in making the diagnosesis of IgE - kappa multiple myeloma. After 4 cycles of ＂bortezomib plus dexamethasone （BD）＂ chemotherapy regimens, the patient＇s clinical symptoms significantly relieved and showed dramatically decreased monoclonal protein and creatinine level in the peripheral blood. Conclusion The situation of multiple myeloma presenting secondary to cervical cancer is rare. Among the whole myeloma cases, IgE type of myeloma occupies the least. So it is important to identify multiple myeloma which has the similar ostalgia symptoms from bone metastases. Furthermore, IgE myeloma has an aggressive clinical courses and poor prognosis. Regarding to therapy, chemotherapy scheme based on bortezomib, for instance BD regimen, has advantages in treating myeloma patients, which can also be used as the initial treatment for IgE multiple myeloma.

关 键 词：宫颈癌 多发性骨髓瘤 IGE 诊断 治疗 预后 

分 类 号：R733.3[医药卫生—肿瘤]