Schmidt U, Ruwe M, Leder L D
Department of Pathology, University of Essen, Germany.
Nouv Rev Fr Hematol (1978). 1995;37(2):159-63.
Multiple myelomas occasionally exhibit bone marrow lesions simulating a concomitant chronic idiopathic myelofibrosis. In the present study, trephine biopsy histologies of such "myelofibrotic" myelomas are described and compared to those from a case of true chronic idiopathic myelofibrosis which developed in the course of chronic lymphocytic leukaemia. "Myelofibrotic" myeloma are characterized by osteosclerosis, marrow fibrosis and focal megakaryocytic hyperplasia in the presence of plasma cell infiltration of the bone marrow. These myelomas are to be distinguished from the more commonly occurring multiple myeloma with simple marrow fibrosis and/or osteosclerosis. Furthermore, "myelofibrotic" myelomas are not identical to myelomas coexisting with true chronic idiopathic myelofibrosis, a condition which would appear to be extremely rare and should only be diagnosed if focal megakaryocytic hyperplasia with atypia can be unequivocally demonstrated. Avoidance of misinterpretation of "myelofibrotic" myeloma requires a knowledge of these different myeloma variants.
多发性骨髓瘤偶尔会出现类似同时存在的慢性特发性骨髓纤维化的骨髓病变。在本研究中，描述了此类“骨髓纤维化型”骨髓瘤的环钻活检组织学特征，并与一例在慢性淋巴细胞白血病病程中发生的真性慢性特发性骨髓纤维化病例的组织学特征进行了比较。“骨髓纤维化型”骨髓瘤的特征是存在骨髓浆细胞浸润的同时伴有骨硬化、骨髓纤维化和局灶性巨核细胞增生。这些骨髓瘤应与更常见的伴有单纯骨髓纤维化和/或骨硬化的多发性骨髓瘤相鉴别。此外，“骨髓纤维化型”骨髓瘤与真性慢性特发性骨髓纤维化并存的骨髓瘤并不相同，这种情况似乎极为罕见，只有在能明确显示伴有异型性的局灶性巨核细胞增生时才能诊断。避免对“骨髓纤维化型”骨髓瘤的误判需要了解这些不同的骨髓瘤变体。
