Hamamoto K, Kosaka C, Takeno M, Anzai N, Tezuka H, Konishi H, Yagiri Y, Ueda Y
Department of Medicine, Kurashiki Central Hospital.
Rinsho Ketsueki. 1990 Jan;31(1):57-61.
A 63-year-old man was admitted to our hospital with a chief complaint of general malaise in March 1986. A diagnosis of Bence Jones protein (kappa) type of multiple myeloma was made from increased atypical plasma cells in the bone marrow, urinary BJP (kappa) and osteolytic lesions. Urinary BJP (kappa) was decreased by MP and VENP therapies. In April 1987, he visited us again with the complaint of pain on the left shoulder. An examination revealed multiple osteolytic lesions and bilateral pleural effusion containing atypical plasma cells. Jaundice was developed at the end of July 1987. An ultrasound examination revealed a hypoechoic mass in the area of pancreatic head. The effusion was gradually increased without response to the treatment. He died of respiratory failure on July 31, 1987. On autopsy, extramedullary plasmacytoma was found in the head of pancreas. It was a rare case of multiple myeloma in which pleural effusion and multiple plasmacytomas, and finally obstructive jaundice were developed although urinary BJP (kappa) was reduced by treatment.
一名63岁男性于1986年3月因全身不适为主诉入院。根据骨髓中异型浆细胞增多、尿本-周蛋白（κ型）及溶骨性病变，诊断为κ型本-周蛋白多发性骨髓瘤。经MP和VENP治疗后，尿本-周蛋白（κ型）减少。1987年4月，他因左肩疼痛再次前来就诊。检查发现多处溶骨性病变及双侧胸腔积液，积液中含有异型浆细胞。1987年7月底出现黄疸。超声检查显示胰头区域有低回声肿块。胸腔积液逐渐增多，治疗无效。患者于1987年7月31日死于呼吸衰竭。尸检发现胰腺头部有髓外浆细胞瘤。这是一例罕见的多发性骨髓瘤病例，尽管经治疗尿本-周蛋白（κ型）减少，但仍出现胸腔积液、多发性浆细胞瘤，最终发展为梗阻性黄疸。
