Hayakawa Hitoshi, Obama Kosuke, Tara Mitsutoshi
Department of Internal Medicine, Kagoshima City Hospital.
Rinsho Ketsueki. 2002 Nov;43(11):1009-13.
In December 1997, a 55-year-old man presented with left-sided back and arm pain. Pretreatment examination revealed IgG-lambda type M-protein, Bence-Jones protein and the posterior mediastinum tumor. Bone marrow examination revealed hypercellular marrow with 73.6% plasma cells. He was diagnosed as having multiple myeloma with extramedullary lesion. As a result of VAD, MP, interferon and radiation therapy, he had a hematological complete remission. After 21 months, he developed intradural relapse at cauda equina and cerebrum. Many plasma cells and IgG-lambda type M-protein were detected in the cerebrospinal fluid. Laboratory examinations showed a complete remission except for cerebral and meningeal involvement. The myeloma cells might have infiltrated the intradural space at diagnosis and expanded in the central nervous system despite chemotherapy. Because reported cases with cerebral and meningeal myeloma are increasing according to the recent advance of treatment, we must pay attention to the meningeal myeloma.
1997年12月，一名55岁男性出现左侧背部和手臂疼痛。治疗前检查发现IgG-λ型M蛋白、本周蛋白以及后纵隔肿瘤。骨髓检查显示骨髓细胞增多，浆细胞占73.6%。他被诊断为多发性骨髓瘤伴髓外病变。经过VAD、MP、干扰素和放射治疗，他获得了血液学完全缓解。21个月后，他在马尾和大脑出现硬膜内复发。脑脊液中检测到许多浆细胞和IgG-λ型M蛋白。实验室检查显示除脑和脑膜受累外完全缓解。骨髓瘤细胞可能在诊断时已浸润硬膜内间隙，并在中枢神经系统中扩散，尽管进行了化疗。由于随着近期治疗进展，脑和脑膜骨髓瘤的报告病例不断增加，我们必须关注脑膜骨髓瘤。
