间变性多发性骨髓瘤3例临床病理学分析  

Anaplastic multiple myeloma:a clinicopathological analysis of three cases

作　　者：曾麟舒 赵媛[1] 张之钰 贾俊梅[2] 陈红[1] ZENG Lin-shu;ZHAO Yuan;ZHANG Zhi-yu;JIA Jun-mei;CHEN Hong(Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Department of Clinical Laboratory,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院石景山院区病理科,北京100043 [2]首都医科大学附属北京朝阳医院石景山院区检验科,北京100043

出　　处：《诊断病理学杂志》2024年第3期226-230,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨间变性多发性骨髓瘤(AMM)的临床病理学特征。方法收集首都医科大学附属北京朝阳医院石景山院区2017—2022年诊断的3例AMM,对其病理学形态、免疫表型及分子病理特征进行回顾性分析。结果男性2例、女性1例,其中2例表现为多发性骨质破坏;1例以髓外病变引发的压迫症状就诊。镜下:由异型性明显的幼稚浆细胞构成,可见多形性核、奇异形核和多核细胞。免疫组化显示肿瘤细胞CD38、CD138和MUM1均弥漫阳性,CD20、CD79α均阴性。免疫球蛋白均为Lambda链限制性表达。分子检测均为高危细胞遗传学异常,主要出现1q21基因扩增。结论AMM较为罕见,组织学形态多形性明显,需与多种肿瘤进行鉴别,具有高危细胞遗传学异常和侵袭性病程,需要引起临床和病理医师的高度重视。Objective To investigate the clinicopathological features of anaplastic multiple myeloma(AMM).Methods The pathological morphology,immunophenotypes and molecular pathological characteristics of 3 AMM cases diagnosed at the Department of Pathology,Beijing Chaoyang Hospital Affiliated to Capital Medical University from 2017 to 2022 were analyzed.Results Two cases were males,and one was female.Among them,two cases were presented with multiple bone destruction.One case was presented with compression symptoms caused mainly by extramedullary lesions.Histologically,the tumor was composed of immature plasma cells with obvious atypia.Polymorphous,singular,and multinucleated cells were seen in some areas.Some nucleoli were seen.Immunohistochemistry showed that CD38,CD138 and MUM1 were diffuse positive,while CD20 and CD79αwere negative.Immunoglobulins were expressed with Lambda chain restriction.Molecular testing showed high-risk cytogenetic abnormalities,mainly involving 1q21 gene amplification.Conclusion AMM is relatively rare,with obvious pleomorphism in histological morphology,and needs to be differentiated from various tumors.It has high-risk cytogenetic abnormalities and invasive disease progression,which requires high attention from clinicians and pathologists.

关 键 词：多发性骨髓瘤 间变性 临床病理特征 免疫组化 鉴别诊断 

分 类 号：R733.3[医药卫生—肿瘤]