Huang Yuanqi, Chen Zhengquan, Wen Kunming
Department of General Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China.
Oncol Lett. 2024 Mar 14;27(5):208. doi: 10.3892/ol.2024.14341. eCollection 2024 May.
Multiple myeloma (MM) and bone metastases are both common malignant tumors of the skeleton that share similar clinical manifestations and radiological features. The development of MM following rectal cancer surgery is relatively rare in clinical practice and is easily misdiagnosed as bone metastasis. The present study reported on a patient with MM and postoperative rectal cancer. A 65-year-old man had been diagnosed with low rectal cancer (poorly differentiated, T3N1M0) 10 years prior and underwent curative treatment at that time. During the 6-year follow-up period, no recurrence or metastasis of rectal cancer was detected. The patient was evaluated for bone pain 4 years ago and underwent multiple imaging examinations, including computed tomography (CT), magnetic resonance imaging, emission CT and positron emission tomography/CT at several well-known hospitals in China. All of these hospitals diagnosed the patient with bone metastasis from rectal cancer, in view of the earlier history. The patient's condition did not show any significant improvement despite treatment for bone metastasis. Subsequently, 3 years ago, the patient underwent surgical treatment at our hospital (Affiliated Hospital of Zunyi Medical University, Zunyi, China) for a hernia near the colostomy site combined with incomplete intestinal obstruction. Post-operatively, the patient developed a hematoma in the surgical area, along with stubborn anemia and abnormal coagulation function. No improvement was observed with hemostasis and multiple blood transfusions. The bone marrow smear was consistent with MM, with a significant elevation in serum IgA and β2 microglobulin. The patient was ultimately diagnosed with MM (IgA-λ type), stage III, according to the Durie-Salmon staging system. The patient's condition improved with treatment for MM.
多发性骨髓瘤（MM）和骨转移瘤都是常见的骨骼恶性肿瘤，具有相似的临床表现和影像学特征。直肠癌手术后发生MM在临床实践中相对少见，且容易误诊为骨转移。本研究报告了1例MM合并直肠癌术后患者。一名65岁男性10年前被诊断为低位直肠癌（低分化，T3N1M0），当时接受了根治性治疗。在6年的随访期内，未检测到直肠癌复发或转移。4年前患者因骨痛接受评估，并在中国几家知名医院接受了包括计算机断层扫描（CT）、磁共振成像、发射型CT和正电子发射断层扫描/CT在内的多项影像学检查。鉴于患者的早期病史，所有这些医院均诊断该患者为直肠癌骨转移。尽管接受了骨转移治疗，但患者的病情没有明显改善。随后，3年前，该患者在我院（中国遵义遵义医科大学附属医院）接受了造口旁疝合并不完全性肠梗阻的手术治疗。术后，患者手术区域出现血肿，伴有顽固性贫血和凝血功能异常。止血和多次输血均未见改善。骨髓涂片符合MM，血清IgA和β2微球蛋白显著升高。根据Durie-Salmon分期系统，该患者最终被诊断为MM（IgA-λ型），Ⅲ期。患者接受MM治疗后病情有所改善。
