Engel Peter A, Lee Ching
Department of Medicine, Division of Geriatrics, VA Medical Center, 113 Holland Ave, Albany, New York 12208, USA, and Albany Medical College, 47 New Scotland Avenue, Albany, New York 12208, USA.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.10.2008.1036. Epub 2009 Mar 5.
An elderly, demented man with stable κ bi-clonal gammopathy of unknown significance suffered a severe displaced right humeral fracture in a fall. One week later a rapidly enlarging head, neck and axillary adenopathy first appeared, including a 2 cm tonsillar node that partially obstructed the oropharynx. A left cervical node biopsy demonstrated diffuse large B cell lymphoma with CD20+, bcl-2+, κ+, CD3-, Epstein-Barr virus negative malignant cells. During the next month lymphadenopathy regressed more than 90% in the absence of treatment with chemotherapeutic agents, radiation or glucocorticoids. Following 2 months of clinical improvement, he died of pneumonia 95 days after the injury. An autopsy demonstrated residual right hilar and mediastinal malignant lymphadenopathy. These unusual events may be related to immunosuppressive and other systemic effects of acute injury on tumour behaviour.
一名患有意义未明的稳定κ双克隆丙种球蛋白病的老年痴呆男性在一次跌倒中发生了严重的右肱骨移位骨折。一周后，首先出现了迅速增大的头部、颈部和腋窝淋巴结病，包括一个2cm的扁桃体结节，该结节部分阻塞了口咽。左颈淋巴结活检显示为弥漫性大B细胞淋巴瘤，其恶性细胞CD20阳性、bcl-2阳性、κ阳性、CD3阴性、Epstein-Barr病毒阴性。在接下来的一个月里，在未使用化疗药物、放疗或糖皮质激素治疗的情况下，淋巴结病消退了90%以上。经过2个月的临床改善后，他在受伤95天后死于肺炎。尸检显示右肺门和纵隔残留恶性淋巴结病。这些不寻常的事件可能与急性损伤对肿瘤行为的免疫抑制及其他全身影响有关。
