Wada H, Ohtsuki T, Sugihara T, Ata K, Hashimoto M, Yamada O, Yawata Y, Manabe T, Miyamoto K
Department of Internal Medicine, Kawasaki Medical School.
Rinsho Ketsueki. 1990 Jul;31(7):1022-7.
The patient was a 64-year-old woman who was admitted to our hospital because of lumbago. A diagnosis of multiple myeloma (non-producing type) was made, based on (1) the presence of multiple osteolytic lesions, (2) hypercellular marrow with 64.2% plasmacytoid malignant cells, (3) no monoclonal gamma-globulin was detected in the serum and urine, and (4) abnormal monoclonal gamma-globulin was also not detected in the cytoplasm and membranes of these malignant cells. After several courses of chemotherapy, a pleural effusion infiltrated by myeloma cells developed and the patient's serum contained a markedly increased amylase activity of salivary-type. Amylase activity was also detected in vitro in the supernatant of cultured myeloma cells established from the patient's pleural effusion. The presence of alpha-amylase in the myeloma cells, which were derived from pleural effusion, was demonstrated immuno-histochemically. These observations indicates that amylase was ectopically produced by these myeloma cells. Interestingly, 14 out of 20 metaphases in the cells derived from pleural effusion showed translocation of 1p22 near the region of 1p21, where the amylase gene was assigned.
该患者为一名64岁女性，因腰痛入院。基于以下几点诊断为多发性骨髓瘤（非分泌型）：（1）存在多个溶骨性病变；（2）骨髓细胞增多，浆细胞样恶性细胞占64.2%；（3）血清和尿液中未检测到单克隆γ球蛋白；（4）这些恶性细胞的细胞质和细胞膜中也未检测到异常单克隆γ球蛋白。经过几个疗程的化疗后，出现了骨髓瘤细胞浸润的胸腔积液，且患者血清中唾液型淀粉酶活性显著升高。从患者胸腔积液中培养的骨髓瘤细胞上清液在体外也检测到了淀粉酶活性。通过免疫组织化学证实了源自胸腔积液的骨髓瘤细胞中存在α淀粉酶。这些观察结果表明这些骨髓瘤细胞异位产生了淀粉酶。有趣的是，源自胸腔积液的细胞中20个中期细胞中有14个显示1p22易位至1p21区域附近，而淀粉酶基因定位于该区域。
