Bataille R, Chappard D, Alexandre C, Dessauw P, Sany J
Br J Cancer. 1986 Jun;53(6):805-10. doi: 10.1038/bjc.1986.136.
Quantitative histology of bone changes, using undecalcified transiliac bone biopsies (UTBB), was performed blindly in 46 individuals with monoclonal gammopathy (MG), including 17 with MG of undetermined significance (MGUS) and 29 with overt multiple myeloma (MM). Three MGUS presented an excess of osteoclastic resorption (OR) in the vicinity of clusters of tumour cells and developed overt B cell malignancies, chronic lymphocytic leukaemia, Waldenström's disease and MM respectively. On the other hand, MGUS with normal OR remained stable (median follow-up = 28 months), with one exception who developed a systemic amyloidosis. In MM, excessive OR was only observed in areas invaded by myeloma cells. OR was frequently normal in active MM lacking myeloma cells in UTBB. Active MM without lesions on radiography had excessive OR. IgA and pure Bence Jones MM appeared more osteoclastic than IgG cases (P less than 0.05). Of major interest was the finding that one third of MM presented histological bone changes similar to osteoporosis, osteosclerosis or osteoblastic metastasis. Two major findings must be emphasized from the current data: UTBB could be of major interest for the early detection of a B cell malignancy; heterogeneity of myeloma bone condition is unexpected. If some changes appear directly related to the tumour (i.e. excessive OR or osteoblastic dysfunction), some others are probably accidentally associated with it (i.e. osteoporosis), both needing treatment other than chemotherapy.
使用未脱钙的髂骨活检（UTBB）对46例单克隆丙种球蛋白病（MG）患者进行了骨变化的定量组织学分析，其中包括17例意义未明的单克隆丙种球蛋白病（MGUS）和29例显性多发性骨髓瘤（MM）。3例MGUS在肿瘤细胞簇附近出现破骨细胞吸收（OR）增加，并分别发展为显性B细胞恶性肿瘤、慢性淋巴细胞白血病、华氏巨球蛋白血症和MM。另一方面，OR正常的MGUS保持稳定（中位随访时间 = 28个月），只有1例发展为系统性淀粉样变性。在MM中，仅在骨髓瘤细胞浸润区域观察到过度的OR。在UTBB中缺乏骨髓瘤细胞的活动性MM中，OR通常正常。X线片上无病变的活动性MM有过度的OR。IgA和纯本-周蛋白MM比IgG病例表现出更多的破骨细胞活性（P小于0.05）。最值得关注的发现是，三分之一的MM呈现出与骨质疏松、骨硬化或成骨细胞转移相似的组织学骨变化。从当前数据中必须强调两个主要发现：UTBB对于早期发现B细胞恶性肿瘤可能具有重要意义；骨髓瘤骨状况的异质性出乎意料。如果一些变化似乎与肿瘤直接相关（即过度的OR或成骨细胞功能障碍），那么其他一些变化可能与肿瘤偶然相关（即骨质疏松），两者都需要化疗以外的治疗。
