Hradská Katarína, Jelínek Tomáš, Ďuraš Juraj, Mihályová Jana, Popková Tereza, Cvek Jakub, Bukovanský Kamil, Havel Martin, Spáčilová Veronika, Hájek Roman
Vnitr Lek. 2020 Spring;66(5):90-95.
In June 2018, 77-year-old man was referred to The Department of Haematooncology, University Hospital Ostrava, for suspicion of multiple myeloma. This was supported by laboratory findings of hypercalcemia, paraprotein IgA κ in serum and by the presence of multiple osteolytic skeletal lesions. Low number of plasma cells in bone marrow sample - cytologically (3.6 %) as well as in flow cytometry (less than 95 % clonal plasma cells out of total bone marrow plasma cells) - pointed at the direction of monoclonal gammopathy of undetermined significance (MGUS). In the course of differential diagnosis of hypercalcemia, elevated level of parathormone had been found which led to the performance of 99mTc-MIBI scintigraphy where parathyroid adenoma was discovered and later histologically verified. The final diagnosis was determined as a coincidence of MGUS and primary hyperparathyroidism. This case report also contains brief differential diagnosis of hypercalcemia and osteolytic skeletal lesions and suggestions for their diagnostic algorithms.
2018年6月，一名77岁男性因疑似多发性骨髓瘤被转诊至俄斯特拉发大学医院血液肿瘤学系。高钙血症、血清中副蛋白IgA κ以及多处溶骨性骨骼病变的实验室检查结果支持了这一诊断。骨髓样本中浆细胞数量较少——细胞学检查为3.6%，流式细胞术检查显示（总骨髓浆细胞中克隆性浆细胞少于95%）——提示意义未明的单克隆丙种球蛋白病（MGUS）。在高钙血症的鉴别诊断过程中，发现甲状旁腺激素水平升高，这导致进行了99mTc-MIBI闪烁扫描，发现了甲状旁腺腺瘤，随后经组织学证实。最终诊断为MGUS与原发性甲状旁腺功能亢进并存。本病例报告还简要介绍了高钙血症和溶骨性骨骼病变的鉴别诊断及其诊断算法建议。
