摘要
目的探讨以肿瘤性胸腔漏出液为主要表现的多发性骨髓瘤病例的临床特点。方法报告解放军总医院血液科2015年收治的1例以肿瘤性胸腔漏出液为主要表现的多发性骨髓瘤病例,就其临床特点及诊疗经过结合相关文献进行回顾性分析。结果患者男性,49岁,双侧胸腔积液导致活动后憋喘,无其他症状。入我院前曾就诊于多家大型医院,由于化验为胸腔漏出液且为唯一临床表现,均重点考虑良性疾病而未能找到病因,曾给予抗感染、抗结核治疗无效,对症给予胸腔置管引流缓解症状。每日自行引流胸腔积液1 500-3 000 ml,病程长达1年,多次复查血清白蛋白正常。入我院后查血清免疫固定电泳Ig G-LAM阳性,提示可能为浆细胞疾病。骨髓涂片浆细胞占4.8%,免疫分型克隆性浆细胞占有核细胞的5.31%。但患者无骨髓瘤相关症状,不符合活动性多发性骨髓瘤诊断标准。且胸腔积液细胞学阴性。采用流式细胞术行胸腔积液免疫分型检查,发现克隆性浆细胞占有核细胞的49.99%,提示胸腔积液为克隆性浆细胞浸润所致,据此确诊为多发性骨髓瘤。结论骨髓瘤性胸腔积液可以为漏出液,且可以为多发性骨髓瘤主要临床表现,但临床罕见。用流式细胞术对胸腔漏出液进行免疫分型检查可提高诊断准确率。
Objective To explore the clinical characteristics of patients with bilateral malignant transudative pleural effusion as main manifestation. Methods One multiple myeloma（MM） patient with bilateral pleural effusion as main manifestation was treated in Chinese PLA General Hospital. The clinical characteristics of the patient were retrospectively analyzed and its related literatures were reviewed. Results The patient was a 49-year-old man. Before admitting to our hospital, he went to many other hospitals. Due to his main symptom being dyspnea after exercise resulting from bilateral transudative pleural effusions for more than one year without anemia, bone disease, renal insufficiency and calcium elevation, it was considered as a benign disease and etiology could not be found. The patient had undergone anti-infection and antiphthisic therapy without any efficacy, and his pleural effusion was drained 1 500-3 000 ml a day by himself. On admission, laboratory tests revealed transudative pleural effusion. Protein electrophoresis of serum was positive for Ig G-LAM, which suggested plasma cell disease. Plasma cells proportion was 4.8% on bone marrow smear with immature morphology. Flow cytometry of BM specimen showed a clonal population of plasma cells（5.31%）, but no symptoms of myeloma were shown in this patient and his symptoms did not met with the diagnostic criterion of active multiple myeloma. Flow cytometry of pleural effusion exhibited a clonal population of myeloma cells, comprising 49.99% of ANC in pleural effusion. The patient was definitively diagnosed with MM. Conclusion Multiple myeloma with bilateral transudative pleural effusion as an initial manifestation is rare, which will be misdiagnosed easily. Flow cytometry of pleural effusion is very useful for diagnosing MM with pleural effusion.
出处
《解放军医学院学报》
CAS
2016年第5期495-497,528,共4页
Academic Journal of Chinese PLA Medical School
基金
解放军总医院科技创新基金(12KMM09)
解放军总医院百项优势项目(YS201451)
关键词
多发性骨髓瘤
胸腔积液
漏出液
浆细胞
multiple myeloma
pleural effusion
transudate
plasma cell
