Yan Ming-Xian
Department of Gastroenterology, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan 250014, Shandong Province, China.
World J Clin Cases. 2024 Aug 6;12(22):5196-5207. doi: 10.12998/wjcc.v12.i22.5196.
Plasma cell myeloma (PCM) is characterized by hypercalcemia, renal impairment, anemia, and bone destruction. While pleural effusion, ascites, abdominal pain, and bloody stool are common manifestations of lung disease or gastrointestinal disorders, they are rarely observed in patients with PCM.
A 66-year-old woman presented with complaints of recurrent chest tightness, wheezing, and abdominal bloating accompanied by bloody stools. Computed tomography revealed pleural effusion and ascites. Pleural effusion tests showed inflammation, but the T-cell spot test and carcinoembryonic antigen were negative. Endoscopy showed colonic mucosal edema with ulcer formation and local intestinal lumen stenosis. Echocardiography revealed enlarged atria and reduced left ventricular systolic function. The diagnosis remained unclear. Further testing revealed elevated blood light chain lambda and urine immunoglobulin levels. Blood immunofixation electrophoresis was positive for immunoglobulin G lambda type. Smear cytology of the bone marrow showed a high proportion of plasma cells, accounting for about 4.5%. Histopathological examination of the bone marrow suggested PCM. Flow cytometry showed abnormal plasma cells with strong expression of CD38, CD138, cLambda, CD28, CD200, and CD117. Fluorescence hybridization gene testing of the bone marrow suggested 1q21 gene amplification, but cytogenetic testing showed no clonal abnormalities. Colonic mucosa and bone marrow biopsy tissues were negative for Highman Congo red staining. The patient was finally diagnosed with PCM.
A diagnosis of PCM should be considered in older patients with pleural effusion, ascites, and multi-organ injury.
浆细胞骨髓瘤（PCM）的特征为高钙血症、肾功能损害、贫血和骨破坏。虽然胸腔积液、腹水、腹痛和便血是肺部疾病或胃肠道疾病的常见表现，但在PCM患者中很少观察到。
一名66岁女性因反复出现胸闷、喘息和腹胀并伴有便血前来就诊。计算机断层扫描显示有胸腔积液和腹水。胸腔积液检查显示有炎症，但T细胞斑点试验和癌胚抗原均为阴性。内镜检查显示结肠黏膜水肿伴溃疡形成及局部肠腔狭窄。超声心动图显示心房扩大，左心室收缩功能降低。诊断仍不明确。进一步检查显示血轻链λ和尿免疫球蛋白水平升高。血液免疫固定电泳显示免疫球蛋白Gλ型阳性。骨髓涂片细胞学检查显示浆细胞比例较高，约占4.5%。骨髓组织病理学检查提示为PCM。流式细胞术显示异常浆细胞，其CD38、CD138、cλ、CD28、CD200和CD117呈强表达。骨髓荧光杂交基因检测提示1q21基因扩增，但细胞遗传学检测未显示克隆异常。结肠黏膜和骨髓活检组织刚果红染色阴性。该患者最终被诊断为PCM。
对于有胸腔积液、腹水和多器官损伤的老年患者，应考虑诊断为PCM。
