Feiner H D, Bannan M, Marsh E, Chuba J V, Espiritu E, Gottesman S R
Department of Pathology, New York University Medical Center, New York City.
Mod Pathol. 1992 Jul;5(4):372-9.
A monoclonal paraprotein in the serum or urine raises the possibility of myeloma. However, in a significant proportion of individuals with serum paraproteins, particularly those with low levels of paraprotein, clinical and routine bone marrow evaluation is not diagnostic of an underlying neoplasm. The purpose of this study was to define the pathologic basis for monoclonal gammopathy in patients whose bone marrow biopsies showed no evidence of myeloma. We used immunofluorescence microscopy and flow cytometry of cell suspensions prepared from aspirated marrow, as well as immunohistochemistry of core biopsies, to perform immunopathologic evaluations of the bone marrow from 26 such patients. Eighteen patients with myeloma and seven without a serum paraprotein or evidence of myeloma were similarly studied. The data indicate that 17 of the 26 patients with monoclonal paraproteins whose routine bone marrow biopsies were normal or nondiagnostic had, in fact, a dispersed monotypic plasma cell population of concordant immunoglobulin heavy and light chain type in the bone marrow demonstrable by at least one of the three analytic methods. Among these, immunofluorescence microscopy of isolated bone marrow mononuclear cells was the most sensitive assay. Immunophenotypic evaluation of the bone marrow is useful for documenting and quantifying a monoclonal plasma cell population in patients with monoclonal gammopathy of undetermined significance.
血清或尿液中的单克隆副蛋白增加了骨髓瘤的可能性。然而，在相当一部分血清中有副蛋白的个体中，尤其是那些副蛋白水平较低的个体，临床和常规骨髓评估并不能诊断出潜在的肿瘤。本研究的目的是确定骨髓活检未显示骨髓瘤证据的患者单克隆丙种球蛋白病的病理基础。我们使用从抽吸骨髓制备的细胞悬液的免疫荧光显微镜检查和流式细胞术，以及核心活检的免疫组织化学，对26例此类患者的骨髓进行免疫病理评估。对18例骨髓瘤患者和7例无血清副蛋白或骨髓瘤证据的患者进行了类似研究。数据表明，26例单克隆副蛋白患者中，其常规骨髓活检正常或无诊断意义的患者中，实际上有17例在骨髓中有分散的单型浆细胞群，其免疫球蛋白重链和轻链类型一致，可通过三种分析方法中的至少一种检测到。其中，分离的骨髓单个核细胞的免疫荧光显微镜检查是最敏感的检测方法。骨髓的免疫表型评估有助于记录和量化意义未明的单克隆丙种球蛋白病患者的单克隆浆细胞群。
