Takada M, Umeda M, Shikoshi K, Shirai T
First Department of Internal Medicine, Toho University School of Medicine, Tokyo.
Rinsho Ketsueki. 1991 Sep;32(9):1001-5.
A 72-year-old male had complained of right back pain and bleeding from his tongue. He was admitted to our department on May 18, 1989. Physical examination revealed hepatosplenomegaly. Peripheral blood findings were as follows: RBC was 3.80 x 10(6)/microliters. Hb 12.2 g/dl, Ht 36.5%, platelet count 735 x 10(3)/microliters, WBC 22,100/microliters, leukoerythroblastosis present. Neutrophil alkaline phosphatase score was normal. Serum vitamin B12 and plasma platelet-derived growth factor level were elevated. Skeletal X-ray revealed multiple punched-out lesions at the 8th thoracic vertebra, and 6th and 8th ribs. Serum IgG level was 3,900 mg/dl. Serum immunoelectrophoresis revealed IgG lambda-type M-protein. Because he complained of severe cervical pain, and skeletal X-ray examination revealed the fracture of 6th cervical vertebra, the operation was performed to remove the lesion. Biopsy of cervical lesion revealed plasmacytoma. M-protein was decreased and the size of the tumor was reduced after treatment with VCAP (vincristine, cyclophosphamide, adriamycin, prednisolone) regimen and interferon-alpha for multiple myeloma.
一名72岁男性主诉右背部疼痛及舌部出血。他于1989年5月18日入住我科。体格检查发现肝脾肿大。外周血检查结果如下：红细胞计数为3.80×10⁶/微升，血红蛋白12.2克/分升，血细胞比容36.5%，血小板计数735×10³/微升，白细胞计数22,100/微升，可见幼粒-幼红细胞血象。中性粒细胞碱性磷酸酶积分正常。血清维生素B₁₂和血浆血小板衍生生长因子水平升高。骨骼X线检查显示第8胸椎、第6和第8肋骨有多个穿凿样病变。血清IgG水平为3900毫克/分升。血清免疫电泳显示IgG λ型M蛋白。由于他主诉严重的颈部疼痛，且骨骼X线检查显示第6颈椎骨折，遂行手术切除病变。颈部病变活检显示为浆细胞瘤。采用治疗多发性骨髓瘤的VCAP（长春新碱、环磷酰胺、阿霉素、泼尼松龙）方案及α干扰素治疗后，M蛋白减少，肿瘤体积缩小。
