Glantz L, Rintels P, Samoszuk M, Medeiros L J
Department of Pathology, Rhode Island Hospital, Providence, USA.
Am J Clin Pathol. 1995 May;103(5):583-7. doi: 10.1093/ajcp/103.5.583.
The association of plasma cell myeloma and eosinophilia is rare. The authors describe a 49-year-old man with plasma cell myeloma and marked absolute peripheral blood eosinophilia, 109.7 x 10(9)/L. Analysis of his bone marrow revealed cytologically atypical plasma cells that expressed monotypic IgG lambda and marked eosinophilia with normal maturation. A combination of steroids and chemotherapy resulted in a significant and sustained decrease in his absolute eosinophil count and bone marrow plasma cells. Analysis of the patient's pre-therapy serum revealed immunoreactive interleukin-3 (IL-3), but not IL-5 or granulocyte/macrophage colony stimulating factor (GM-CSF). The post-therapy serum sample was negative. Immunohistochemical analysis of the plasma cells for IL-3 and IL-5 was negative. This review of the literature has revealed five cases of plasma cell myeloma associated with eosinophilia described previously. In two patients, the eosinophilia was attributed to drug therapy. In the remaining cases, the pathogenesis of the eosinophilia was unexplained. In this case, IL-3 secreted either by the neoplastic cells at a level below detection by immunohistochemistry or by other cells in response to the presence of plasma cell myeloma may have played a role in causing the eosinophilia.
浆细胞骨髓瘤与嗜酸性粒细胞增多症的关联较为罕见。作者描述了一名49岁患有浆细胞骨髓瘤且外周血绝对嗜酸性粒细胞显著增多（109.7×10⁹/L）的男性。对其骨髓进行分析发现，细胞学上非典型的浆细胞表达单克隆IgG λ，且嗜酸性粒细胞显著增多但成熟正常。类固醇和化疗联合治疗使其绝对嗜酸性粒细胞计数和骨髓浆细胞显著且持续减少。对该患者治疗前血清的分析显示存在免疫反应性白细胞介素-3（IL-3），但不存在IL-5或粒细胞/巨噬细胞集落刺激因子（GM-CSF）。治疗后血清样本检测为阴性。对浆细胞进行IL-3和IL-5的免疫组化分析结果为阴性。对文献的回顾发现了先前描述的5例与嗜酸性粒细胞增多症相关的浆细胞骨髓瘤病例。在2例患者中，嗜酸性粒细胞增多症归因于药物治疗。在其余病例中，嗜酸性粒细胞增多症的发病机制不明。在本病例中，肿瘤细胞分泌的IL-3（免疫组化检测水平低于检测下限）或其他细胞对浆细胞骨髓瘤的反应所分泌的IL-3可能在导致嗜酸性粒细胞增多症中发挥了作用。
