Moran C A, Suster S, Fishback N F, Koss M N
Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Mod Pathol. 1995 Apr;8(3):257-9.
We present two cases of extramedullary plasmacytoma presenting as a mediastinal mass and preceding the onset of full-blown multiple myeloma. The patients are a 62-year-old woman who presented with progressive dyspnea and left-sided chest pain and a 59-year-old asymptomatic man. In both patients, radiographic studies revealed a posterior and anterior mediastinal mass, respectively. Surgical resection of the tumor was performed in the two cases. The tumors were characterized by a well-circumscribed proliferation of plasma cells surrounded by residual lymph nodal tissue. Immunohistochemical studies on paraffin sections demonstrated lambda light chain restriction. Follow-up in our patients revealed that both of them developed multiple myeloma after 6 months and 2 years, respectively. One patient received treatment with melphalan and prednisone and is currently alive and well without evidence of disease, 2 years after diagnosis. The second patient died 4 years after resection of his tumor with evidence of disease in lumbar spine, skull, and lungs. Extramedullary plasmacytoma presenting as a mediastinal mass may precede the onset of full-blown multiple myeloma; therefore, institution of early systemic therapy in these patients may be of value in preventing further progression of the disease.
我们报告了两例髓外浆细胞瘤，均表现为纵隔肿块，且在典型多发性骨髓瘤发病之前出现。患者分别为一名62岁出现进行性呼吸困难和左侧胸痛的女性以及一名59岁无症状男性。在这两名患者中，影像学检查分别显示后纵隔和前纵隔肿块。两例均进行了肿瘤手术切除。肿瘤的特征是浆细胞呈边界清楚的增生，周围有残留的淋巴结组织。石蜡切片免疫组化研究显示λ轻链限制。对我们的患者进行随访发现，他们分别在6个月和2年后发展为多发性骨髓瘤。一名患者接受了美法仑和泼尼松治疗，诊断后2年目前存活且情况良好，无疾病迹象。第二名患者在肿瘤切除后4年死亡，腰椎、颅骨和肺部有疾病迹象。表现为纵隔肿块的髓外浆细胞瘤可能在典型多发性骨髓瘤发病之前出现；因此，对这些患者早期进行全身治疗可能对预防疾病进一步进展有价值。
