Importance of quantitative histology of bone changes in monoclonal gammopathy.
Importance of quantitative histology of bone changes in monoclonal gammopathy.
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DOI：
10.1038/bjc.1986.136
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发表时间：
1986-06
影响因子：
8.8
通讯作者：
Sany J
中科院分区：
文献类型：
--
作者：
Bataille R;Chappard D;Alexandre C;Dessauw P;Sany J
对46例单克隆丙种球蛋白病（MG）患者，包括17例意义不明的MG（MGUS）和29例明显的多发性骨髓瘤（MM），采用不脱钙髂骨间骨活检（UTBB）进行了骨变化的定量组织学盲法研究。3例MGUS在肿瘤细胞簇附近表现出过量的骨吸收（OR），并分别发展为明显的B细胞恶性肿瘤、慢性淋巴细胞白血病、Waldenström病和MM。另一方面，具有正常OR的MGUS保持稳定（中位随访= 28个月），只有一个例外，该患者发生了系统性淀粉样变性。在MM中，仅在骨髓瘤细胞侵袭的区域观察到过度OR。UTBB中缺乏骨髓瘤细胞的活动性MM的OR通常正常。放射学检查无病变的活动性MM的OR过高。伊加和单纯Bence Jones型MM的骨密度均高于IgG型（P <0.05）。主要关注的是发现三分之一的MM表现出与骨质疏松症、骨质疏松或成骨细胞转移相似的组织学骨变化。从目前的数据中必须强调两个主要的发现：UTBB可能对B细胞恶性肿瘤的早期检测具有重要意义;骨髓瘤骨状况的异质性是出乎意料的。如果某些变化与肿瘤直接相关（即过度OR或成骨细胞功能障碍），则其他一些变化可能与肿瘤意外相关（即骨质疏松症），两者都需要化疗以外的治疗。
Quantitative histology of bone changes, using undecalcified transiliac bone biopsies (UTBB), was performed blindly in 46 individuals with monoclonal gammopathy (MG), including 17 with MG of undetermined significance (MGUS) and 29 with overt multiple myeloma (MM). Three MGUS presented an excess of osteoclastic resorption (OR) in the vicinity of clusters of tumour cells and developed overt B cell malignancies, chronic lymphocytic leukaemia, Waldenström's disease and MM respectively. On the other hand, MGUS with normal OR remained stable (median follow-up = 28 months), with one exception who developed a systemic amyloidosis. In MM, excessive OR was only observed in areas invaded by myeloma cells. OR was frequently normal in active MM lacking myeloma cells in UTBB. Active MM without lesions on radiography had excessive OR. IgA and pure Bence Jones MM appeared more osteoclastic than IgG cases (P less than 0.05). Of major interest was the finding that one third of MM presented histological bone changes similar to osteoporosis, osteosclerosis or osteoblastic metastasis. Two major findings must be emphasized from the current data: UTBB could be of major interest for the early detection of a B cell malignancy; heterogeneity of myeloma bone condition is unexpected. If some changes appear directly related to the tumour (i.e. excessive OR or osteoblastic dysfunction), some others are probably accidentally associated with it (i.e. osteoporosis), both needing treatment other than chemotherapy.