Patterson J W, Parsons J M, White R M, Fitzpatrick J E, Kohout-Dutz E
Department of Pathology, Medical College of Virginia Commonwealth University, Richmond.
J Am Acad Dermatol. 1988 Nov;19(5 Pt 1):879-90. doi: 10.1016/s0190-9622(88)70249-2.
We recently performed a retrospective clinicopathologic study of five patients with cutaneous involvement of multiple myeloma or extramedullary plasmacytoma. Cutaneous nodules without extension from an underlying bony focus of disease developed in each case. In two cases skin lesions occurred in the more common setting of advanced disease, but in two others skin lesions provided early clues to the diagnosis. In three patients the appearance of skin lesions heralded a rapidly deteriorating clinical course, but two other patients had reasonably long survivals despite cutaneous disease (6 and 3 years, respectively). Two histopathologic configurations were identified in cutaneous lesions: nodular and infiltrative. Both patients with the latter form had multiple myeloma. In all cases tumor cells were pyroninophilic. Immunoperoxidase studies on fixed, paraffin-embedded tissues confirmed the electrophoretic findings in two cases, but findings were equivocal in three others. In one case, cells were positive for epithelial membrane antigen, and in another, alpha 1-antichymotrypsin-positive cells were observed in the centers of tumor islands. Cutaneous involvement with plasma cell neoplasms is recognized infrequently. Immunohistochemical techniques may prove to be valuable in evaluating these cases, but they are not without technical and interpretative difficulties.
我们最近对5例患有多发性骨髓瘤或髓外浆细胞瘤皮肤受累的患者进行了一项回顾性临床病理研究。每例患者均出现了无潜在骨病病灶扩展的皮肤结节。2例患者的皮肤病变发生在晚期疾病这种更常见的情况下，但另外2例患者的皮肤病变为诊断提供了早期线索。3例患者皮肤病变的出现预示着临床病程迅速恶化，但另外2例患者尽管患有皮肤疾病仍存活了相当长的时间（分别为6年和3年）。在皮肤病变中发现了两种组织病理学形态：结节状和浸润性。后一种形态的2例患者均患有多发性骨髓瘤。在所有病例中，肿瘤细胞均为嗜派洛宁性。对固定的石蜡包埋组织进行的免疫过氧化物酶研究在2例中证实了电泳结果，但在另外3例中结果不明确。1例患者的细胞上皮膜抗原呈阳性，另1例在肿瘤岛中心观察到α1抗糜蛋白酶阳性细胞。浆细胞肿瘤累及皮肤的情况很少见。免疫组织化学技术在评估这些病例时可能被证明是有价值的，但它们并非没有技术和解释方面的困难。
