Anterior mediastinum invasion by multiple myeloma: A case report.
Anterior mediastinum invasion by multiple myeloma: A case report.
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多发性骨髓瘤侵犯前纵隔：病例报告。
DOI：
10.3892/ol.2017.5756
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发表时间：
2017-04
期刊：
影响因子：
2.9
通讯作者：
Ma KW
中科院分区：
文献类型：
--
作者：
Xu YH;Sun LG;Sun C;Bai O;Liang TT;Ma KW
多发性骨髓瘤 (MM) 是骨髓 (BM) 中恶性浆细胞的克隆性增殖，在血清和尿液中分泌单克隆副蛋白。骨髓MM细胞可侵入并损害其他组织器官的功能，如肺、脾、肝、胰、肾和淋巴结等。然而，主要位于 BM 的 MM 细胞侵入胸腺部位的前纵隔是极其罕见的事件。目前的研究报告了一名 53 岁女性的病例，她患有前纵隔受累的 MM。诊断基于临床影像分析以及BM和实验室检查、局部活检病理学和免疫组织化学的结果。患者接受了两个疗程的化疗（表阿霉素、地塞米松和沙利度胺）。结果，肿瘤尺寸缩小，但实验室检查显示没有明显变化。接下来，患者转为一个疗程的 PAD 化疗（硼替佐米、表柔比星和地塞米松）。此次化疗后原肿瘤明显缩小，各项指标均有所改善。目前的研究表明MM对胸腺的侵袭可能会导致异常胸腺引起的免疫紊乱。临床上应仔细区分胸腺髓外浆细胞瘤和胸腺瘤。
Multiple myeloma (MM) is a clonal proliferation of malignant plasma cells in the bone marrow (BM) that secretes monoclonal paraproteins in the blood serum and urine. Bone marrow MM cells can invade and damage the functions of other tissues and organs, such as the lungs, spleen, liver, pancreas, kidneys and lymph nodes. However, the invasion of MM cells primarily located in the BM to the anterior mediastinum at the site of the thymus is an extremely rare event. The current study reports the case of a 53-year-old female who presented with MM with involvement of the anterior mediastinum. The diagnosis was based on clinical imaging analyses and the results from BM and laboratory examinations, local biopsy pathology and immunohistochemistry. The patient was administered two courses of chemotherapy (epirubicin, dexamethasone and thalidomide). As a result, the tumor reduced in size, but the laboratory examination indicated no significant change. Next, the patient was switched to one course of PAD chemotherapy (bortezomib, epirubicin and dexamethasone). The original tumor was significantly reduced in size following this chemotherapy, and all the indicators improved. The present study suggests that invasion of the thymus by MM may lead to immune disturbance arising from the abnormal thymus gland. In the clinic, extramedullary plasmacytoma in the thymus should be carefully distinguished from thymoma.