Oda K, Egawa H, Okuhara T, Sakai A, Hyohdou H, Tanaka H, Kuramoto A
Department of Internal Medicine, Hiroshima City Asa Hospital, Japan.
Cancer. 1991 Apr 1;67(7):1900-2. doi: 10.1002/1097-0142(19910401)67:7<1900::aid-cncr2820670714>3.0.co;2-a.
A case of Bence Jones kappa multiple myeloma with meningeal involvement in a 64-year-old woman is presented. Three years after the diagnosis of multiple myeloma, gait disturbances developed followed by visual disorders and impaired consciousness. A lumbar puncture revealed numerous atypical plasma cells in the cerebrospinal fluid. Craniospinal irradiation and intrathecal injections of methotrexate, cytarabine, and prednisolone were effective for a short period. At autopsy, the leptomeninges were infiltrated diffusely with atypical plasma cells. A review of the literature showed that multiple myeloma with meningeal involvement is accompanied frequently by circulating atypical plasma cells or plasma cell leukemia. Meningeal involvement is a rare complication and shows poor prognosis in cases of multiple myeloma.
本文报告了一例64岁女性患有本斯·琼斯κ型多发性骨髓瘤并伴有脑膜受累的病例。在多发性骨髓瘤确诊三年后，出现步态障碍，随后出现视觉障碍和意识障碍。腰椎穿刺显示脑脊液中有大量非典型浆细胞。颅脊髓照射以及鞘内注射甲氨蝶呤、阿糖胞苷和泼尼松龙在短期内有效。尸检时，软脑膜被非典型浆细胞弥漫性浸润。文献回顾显示，伴有脑膜受累的多发性骨髓瘤常伴有循环中的非典型浆细胞或浆细胞白血病。脑膜受累是一种罕见的并发症，在多发性骨髓瘤病例中预后较差。
