Kawauchi K, Ogasawara T, Yasuyama M, Ohkawa S, Aiba M
Department of Medicine, Tokyo Women's Medical University Daini Hospital.
Rinsho Ketsueki. 2001 Nov;42(11):1128-33.
A 65-year-old man was admitted to our hospital in September 1997 because of back pain and renal dysfunction. He was diagnosed as having multiple myeloma due to the presence of IgD lambda monoclonal gammopathy and diffuse infiltration of plasma cells in the bone marrow. The patient achieved a partial response to DMVM-IFN-alpha combination therapy. His condition worsened in December 1998, but was ameliorated by VAD therapy. The patient's left testis became enlarged in December 1999, and an orchiectomy was performed. The normal testicular cells had been entirely displaced by myeloma cells comprising typical plasma cells and large lymphoid cells. Pleural, mediastinal, spinal, and right testicular involvement with myeloma subsequently developed. Despite attempts to treat the patient with more than one type of combination therapy, his condition worsened progressively, and he died in June 2000. Reports of IgD myeloma with testicular involvement are rare. The histopathology of our patient's resected testis, i.e. the two myeloma cell-plasmacytoid and lymphoid cell components showing differential immunostaining, was unique.
一名65岁男性于1997年9月因背痛和肾功能不全入院。由于存在IgD λ单克隆丙种球蛋白病以及骨髓中浆细胞的弥漫性浸润，他被诊断为多发性骨髓瘤。该患者对DMVM - IFN-α联合治疗取得了部分缓解。他的病情在1998年12月恶化，但通过VAD治疗得到改善。患者的左侧睾丸在1999年12月肿大，并进行了睾丸切除术。正常的睾丸细胞已完全被由典型浆细胞和大淋巴细胞组成的骨髓瘤细胞取代。随后出现了骨髓瘤累及胸膜、纵隔、脊柱和右侧睾丸的情况。尽管尝试用多种联合治疗方法对该患者进行治疗，但其病情仍逐渐恶化，并于2000年6月死亡。IgD骨髓瘤累及睾丸的报道很少见。我们患者切除睾丸的组织病理学，即两种骨髓瘤细胞成分——浆细胞样和淋巴细胞样细胞显示出不同的免疫染色，是独特的。
