摘要
目的总结伴胸腔侵犯多发性骨髓瘤(MM)患者的临床及实验室特征。方法回顾并分析山东大学附属威海市立医院收治6例伴胸腔侵犯MM患者的实验室检测结果,包括血红蛋白(Hb)、血生化检测、骨髓象检验、胸腔积液常规、细胞形态学及免疫表型、遗传学检查结果等临床资料。结果在6例患者中,初诊时高血钙3例,肾功能受损4例,中度贫血5例,轻度贫血1例,乳酸脱氢酶(LDH)升高2例,β2-微球蛋白(β2-MG)升高6例,白蛋白降低5例。骨髓涂片瘤细胞比例为12.0%~76.5%,其中<20%、20%~50%、>50%分别有1例、3例、2例。免疫固定电泳结果可见,免疫球蛋白G(IgG)型1例、免疫球蛋白A(IgA)型4例、轻链λ型1例。胸水均为渗出液,涂片可见,骨髓瘤细胞比例为1%~93%。瘤细胞表达CD38、CD117,细胞质轻链限制性表达,部分表达CD138、CD56,不表达CD19。细胞遗传学异常(CA)检出5例,其中:1q+检出3例,17p-检出1例,t(4;14)检出2例,t(14;16)未检出,t(14;20)未检出,13q-检出1例,t(11;14)检出2例,IgH重排(14q32)检出3例。结论伴胸腔侵犯MM患者初诊时具有典型CRAB症状,胸水中可见骨髓瘤细胞,瘤细胞多表达CD38、CD138和CD56,患者多携带高危CA。积液细胞形态学和流式细胞术(FCM)免疫表型检查是诊断伴胸腔侵犯MM的主要依据。
Objective To summarize the clinical and laboratory characteristics of multiple myeloma(MM)patients with thoracic invasion.Methods The laboratory test results of 6 cases of MM patients with thoracic invasion admitted to Weihai Municipal Hospital,Cheeloo College of Medicine,Shandong University were reviewed and analyzed,including hemoglobin(Hb),blood biochemical test,bone marrow examination,routine pleural effusion,cytomorphology and immunophenotype,genetic examination results and other clinical data.Results Among the six patients at the time of initial diagnosis,three cases had hypercalcemia,four cases had impaired renal function,five cases had moderate anemia and one case had mild anemia,two cases had increased lactic dehydrogenase(LDH)level,six cases had increasedβ2-microglobulin(β2-MG)level,and five cases had decreased albumin.Bone marrow cytology in 6 patients showed myeloma cell proportions ranged from 12.0%to 76.5%,including one patient with less than 20%,three patients with myeloma cells between 20%and 50%,and two patients with myeloma cells greater than 50%.Immunofixation electrophoresis showed one case of immunoglobulin G(IgG)type,four cases of immunoglobulin A(IgA)type,and one case of cytoplasmic light chainλtype.Pleural effusion was exudative,and the cytology showed myeloma cells accounting for 1%to 93%.Myeloma cells expressed CD38 and CD117,with restricted expression of cytoplasmic light chains,partial expression of CD138 and CD56,and without expression of CD19.Cytogenetic abnormalities(CA)were detected in 5 of the 6 patients,including 3 cases of 1q+,1 case of 17p-,2 cases of t(4;14),no detection of t(14;16),no detection of t(14;20),1 case of 13q-,2 cases of t(11;14),and 3 cases of IgH rearrangement(14q32).Conclusions MM with thoracic invasion is initially diagnosed with typical CRAB symptoms,and myeloma cells could be seen in the pleural effusion,which mostly express CD38,CD138 and CD56,and patients often carry high-risk CA.Pleural effusion cytomorphology and immunophenotyping by flow cytometry are the main basis for the diagnosis of MM with thoracic invasion.
作者
高胜海
王晓毅
朱海燕
Gao Shenghai;Wang Xiaoyi;Zhu Haiyan(Department of Clinical Laboratory,Weihai Municipal Hospital,Cheeloo College of Medicine,Shandong University,Weihai 264200,Shandong,China;Department of Hematology,Weihai Municipal Hospital,Cheeloo College of Medicine,Shandong University,Weihai 264200,Shandong,China)
出处
《实用检验医师杂志》
2023年第2期189-192,共4页
Chinese Journal of Clinical Pathologist
