Pika Tomas, Bacovsky Jaroslav, Vaverka Miroslav, Hrbek Jan, Hubacek Jaromir, Spurna Dagmar, Scudla Vlastimil
Department of Internal Medicine III, University Hospital and Palacky University, Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009 Dec;153(4):271-3. doi: 10.5507/bp.2009.045.
Involvement of the central nervous system as the first manifestation of multiple myeloma is very rare.
To present an unusual case of the primomanifestation of a multiple myeloma in the form of a focal affection of the central nervous system in a patient with chronic lymphocytic leukaemia.
A female patient diagnosed with chronic B-lymphocytic leukaemia with gradually increasing right-sided cerebellar symptomatology. The CT examination revealed expansion of the cranial vault with significant compression of brain structures. The tumour was extirpated and the histological examination led to a diagnosis of a plasmocytic myeloma. A thorough examination confirmed the diagnosis of multiple myeloma with significant osteolytic involvement of the skeleton. A combined chemo- and radiotherapy resulted in adjustment in the focal neurological finding, and a partial remission of the multiple myeloma was achieved.
The above presented case describes two very unusual states: the primomanifestation of a multiple myeloma in form of a focal affection of the central nervous system, and the coincidence of a multiple myeloma as the second haematological malignancy in a patient with chronic B-lymphocytic leukaemia.
多发性骨髓瘤以中枢神经系统受累作为首发表现极为罕见。
呈现一例不寻常病例，一名慢性淋巴细胞白血病患者以中枢神经系统局灶性病变的形式出现多发性骨髓瘤的首发表现。
一名女性患者被诊断为慢性B淋巴细胞白血病，右侧小脑症状逐渐加重。CT检查显示颅腔扩大，脑结构明显受压。肿瘤被切除，组织学检查确诊为浆细胞骨髓瘤。全面检查证实为多发性骨髓瘤，骨骼有明显溶骨性病变。放化疗联合治疗使局灶性神经症状得到改善，多发性骨髓瘤部分缓解。
上述病例描述了两种非常不寻常的情况：多发性骨髓瘤以中枢神经系统局灶性病变的形式首发，以及多发性骨髓瘤作为慢性B淋巴细胞白血病患者的第二种血液系统恶性肿瘤与之并存。
