Scullin D C, Cohen H J
Am J Hematol. 1979;6(3):267-73. doi: 10.1002/ajh.2830060311.
Multiple myeloma is a disease that infrequently involves nonreticuloendothelial tissues and rarely causes pleural effusion. A 59-year-old woman had pleural effusion as the major manifestation of multiple myeloma. Light microscopy of her pleural fluid with Wright stained preparations showed all cells to be bizarre and often multinucleated plasmacytes. Electron microscopy confirmed these results. Intracellular immunofluorescence revealed IgG-kappa immunoglobulin (Ig) in greater than 90% of these cells. Surface immunofluorescence using anti-Ig sera was seen on less than 5% of the pleural fluid cells. 3H leucine incorporation into Ig in vitro was measured for these cells, and secretory curves were obtained that have the typical secretory kinetics of bone marrow plasmacytes. This demonstrates that such cells are viable and are able to synthesize and release immunoglobulin. Treatment of our patient with prednisone, melphalan, and cyclophosphamide resulted in symptomatic improvement and complete resolution of her pleural effusion. Pleural effusion is an unusual but important complication of multiple myeloma and does not necessarily carry the grave prognosis implied in previous reports.
多发性骨髓瘤是一种很少累及非网状内皮组织且极少引起胸腔积液的疾病。一名59岁女性以胸腔积液为多发性骨髓瘤的主要表现。对其胸腔积液进行瑞氏染色制片的光镜检查显示，所有细胞均为形态怪异且常为多核的浆细胞。电镜检查证实了这些结果。细胞内免疫荧光显示，超过90%的这些细胞中存在IgG-κ免疫球蛋白（Ig）。使用抗Ig血清进行的表面免疫荧光在不到5%的胸腔积液细胞中可见。对这些细胞进行了体外3H亮氨酸掺入Ig的测定，并获得了具有典型骨髓浆细胞分泌动力学的分泌曲线。这表明此类细胞具有活力，能够合成并释放免疫球蛋白。对我们的患者使用泼尼松、美法仑和环磷酰胺进行治疗后，症状得到改善，胸腔积液完全消退。胸腔积液是多发性骨髓瘤一种不常见但重要的并发症，并不一定具有既往报道中所暗示的严重预后。
