Van Slyck E J, Kleerekoper M, Abraham J P, Deegan M J
Am J Med Sci. 1986 May;291(5):347-51. doi: 10.1097/00000441-198605000-00011.
Two patients, ultimately found to have advanced nonsecretory multiple myeloma, presented with skeletal pain, diffuse skeletal demineralization, and fractures. The correct diagnosis was initially obscured by the absence of typical hematologic findings and discrete lytic bone lesions. Bone marrow examination was diagnostic. Intracytoplasmic IgA or IgD kappa was demonstrated in the myeloma cells of each case. Decreased quantitative polyclonal serum immunoglobulins and hypercalcemia were important clinical clues. The demonstration of increased osteoclast activating factor (OAF) derived from the cultured myeloma cells from each case suggests that the secretion of OAF and immunoglobulin are unrelated.
两名最终被诊断为晚期非分泌型多发性骨髓瘤的患者，表现为骨骼疼痛、弥漫性骨质脱矿质和骨折。最初，由于缺乏典型的血液学表现和离散的溶骨性骨病变，正确诊断受到了阻碍。骨髓检查具有诊断意义。在每例患者的骨髓瘤细胞中均发现了胞浆内IgA或IgD κ链。血清定量多克隆免疫球蛋白降低和高钙血症是重要的临床线索。对每例患者培养的骨髓瘤细胞衍生的破骨细胞激活因子（OAF）增加的证明表明，OAF的分泌与免疫球蛋白无关。
