Kalantri Siddhesh Arun, Nath Uttam Kumar, Banerjee Debasis, Bhattacharyya Maitreyee
Medical College and Hospital Kolkata, Institute of Haematology and Transfusion Medicine, Kolkata, West Bengal, India.
Department of Medical Oncology and Haematology, All India Institute of Medical Sciences-Rishikesh, Rishikesh, Uttarakhand, India.
BMJ Case Rep. 2017 Mar 20;2017:bcr2016218901. doi: 10.1136/bcr-2016-218901.
Plasmablastic lymphoma, a rare highly aggressive non-Hodgkin's lymphoma subtype, often associated with HIV infection, is a close differential diagnosis of plasmablastic myeloma. The 2 conditions may be morphologically and immunophenotypically identical. However, differentiating between the 2 conditions is critical for adequate patient management. Herein, we describe an unusual case of plasmablastic myeloma with biclonal gammopathy which was initially diagnosed as plasmablastic lymphoma based on lymph node biopsy and immunohistochemistry (IHC) results. The incidental finding of lytic bone lesion on imaging prompted further investigations. The presence of multiple osteolytic lesions, biclonal gammopathy on serum protein electrophoresis and immunofixation, negative Epstein-Barr virus-encoded small RNAs on IHC led to revision of the diagnosis to plasmablastic variant of multiple myeloma. The patient was initially started on bortezomib plus dose-adjusted EPOCH chemotherapy for plasmablastic lymphoma. Subsequently, he was treated with RVD (lenalidomide, bortezomib, dexamethasone) regimen for plasmablastic myeloma and he achieved stringent complete response after 4 cycles.
浆母细胞淋巴瘤是一种罕见的侵袭性很强的非霍奇金淋巴瘤亚型，常与HIV感染相关，是浆母细胞骨髓瘤的相近鉴别诊断对象。这两种疾病在形态学和免疫表型上可能相同。然而，区分这两种疾病对于患者的恰当管理至关重要。在此，我们描述了一例伴有双克隆丙种球蛋白病的浆母细胞骨髓瘤不寻常病例，该病例最初根据淋巴结活检和免疫组织化学（IHC）结果被诊断为浆母细胞淋巴瘤。影像学上偶然发现的溶骨性病变促使进一步检查。多处溶骨性病变的存在、血清蛋白电泳和免疫固定电泳显示的双克隆丙种球蛋白病、免疫组织化学检查中爱泼斯坦-巴尔病毒编码的小RNA呈阴性，导致诊断修正为多发性骨髓瘤的浆母细胞变异型。该患者最初开始接受硼替佐米联合剂量调整的EPOCH化疗方案治疗浆母细胞淋巴瘤。随后，他接受了用于浆母细胞骨髓瘤的RVD（来那度胺、硼替佐米、地塞米松）方案治疗，4个周期后达到严格完全缓解。
