Zukerberg L R, Ferry J A, Conlon M, Harris N L
Department of Pathology, Harvard Medical School, Boston, Massachusetts.
Am J Clin Pathol. 1990 May;93(5):657-61. doi: 10.1093/ajcp/93.5.657.
The neoplastic cells in most cases of multiple myeloma closely resemble normal plasma cells. The authors report six cases of myeloma in which most of the neoplastic cells had cleaved, multilobated, or monocytoid nuclei and presented some diagnostic difficulty. All cases were clinically aggressive (five patients with stage III disease and one patient with stage II disease). Three patients died during their initial hospitalization, and three patients are alive with progressive disease from 5 to 14 months after combination chemotherapy. Immunohistochemical studies on paraffin-embedded tissue demonstrated monotypic immunoglobulin in each case (three lambda and three kappa). Recognition of these morphologic variants of neoplastic plasma cells is important to the pathologist to avoid erroneous diagnoses and to alert the clinician to an aggressive form of myeloma associated with a poor prognosis. Immunohistochemical studies on paraffin-embedded tissue sections are useful in the diagnosis of this tumor.
在大多数多发性骨髓瘤病例中，肿瘤细胞与正常浆细胞极为相似。作者报告了6例骨髓瘤病例，其中大多数肿瘤细胞具有核分裂、多叶核或单核样核，给诊断带来了一定困难。所有病例临床侵袭性均较强（5例为Ⅲ期疾病，1例为Ⅱ期疾病）。3例患者在初次住院期间死亡，3例患者在联合化疗后5至14个月仍存活且疾病进展。对石蜡包埋组织进行的免疫组织化学研究显示，每例均有单型免疫球蛋白（3例为λ型，3例为κ型）。认识到肿瘤性浆细胞的这些形态学变异对病理学家很重要，可避免错误诊断，并提醒临床医生注意一种预后不良的侵袭性骨髓瘤形式。对石蜡包埋组织切片进行免疫组织化学研究有助于该肿瘤的诊断。
