Dhingra Kajal Kiran, Singhal Niti, Nigam Sonu, Jain Shayama
Department of Pathology, Maulana Azad Medical College and Lok Nayak Hospital, Bahadur Shah Zafar Marg, New Delhi 110002, India.
Cytojournal. 2007 Sep 7;4:17. doi: 10.1186/1742-6413-4-17.
Multiple Myeloma presenting as a pleural effusion is extremely rare. It is usually a late complication and is associated with a poor prognosis.
A 40-year-old male presented with dyspnea and fever of six months duration. Clinical diagnosis of pulmonary tuberculosis was considered. X-ray chest showed bilateral pleural effusion. Pleural cytology revealed numerous plasma cells, some of which were binucleated and atypical. Cytological differential diagnosis included: Myelomatous effusion and Non-Hodgkin's Lymphoma deposit (Immunoblastic type). Bone marrow biopsy, serum protein electrophoresis and bone scan confirmed the diagnosis of multiple myeloma (Plasmablastic type).
Myelomatous pleural effusion as an initial presentation although extremely rare, should always be considered in presence of atypical plasma cells irrespective of age.
以胸腔积液形式出现的多发性骨髓瘤极为罕见。它通常是一种晚期并发症，且预后较差。
一名40岁男性，出现持续6个月的呼吸困难和发热症状。考虑为肺结核的临床诊断。胸部X线显示双侧胸腔积液。胸腔细胞学检查发现大量浆细胞，其中一些为双核且形态异常。细胞学鉴别诊断包括：骨髓瘤性胸腔积液和非霍奇金淋巴瘤沉积物（免疫母细胞型）。骨髓活检、血清蛋白电泳和骨扫描确诊为多发性骨髓瘤（浆母细胞型）。
骨髓瘤性胸腔积液作为首发表现虽然极为罕见，但无论年龄大小，只要存在非典型浆细胞就应始终予以考虑。
