Lee G C, Hong J S, Lee K H, Kim S B, Kim S W, Suh C W, Lee J S, Chi H S, Kim S H
Department of Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Korean J Intern Med. 1994 Jul;9(2):113-5. doi: 10.3904/kjim.1994.9.2.113.
A rare case of coexisting multiple myeloma and non-Hodgkin's lymphoma at the time of diagnosis is presented. The patient presented with petechiae, melena and weight loss. IgA lambda monoclonal gammopathy in the serum and free lambda chain in urine were documented. Bone marrow biopsy demonstrated an interstitial infiltration of neoplastic plasma cells coexisting with localized collection of neoplastic lymphoid cells composed of monotonous small lymphocytes with occasional cleaved nuclei. Immunophenotype of plasma cell was IgA lambda. The patient also had a jejunal mass, with biopsy proven malignant lymphoma, diffuse small cleaved cell type. The tumor was diffusely positive for pan-B marker. After chemotherapy, the IgA lambda monoclonal protein decreased and the patient improved. This case suggest, that the seound B-cell neoplasm may have evolved by transformation of an original neoplastic clone, or that malignant tumors may be polyclonal at onset. Definitive diagnosis and staging of each disorder is important for proper management.
本文报告了一例诊断时同时存在多发性骨髓瘤和非霍奇金淋巴瘤的罕见病例。患者表现为瘀点、黑便和体重减轻。血清中检测到IgA λ单克隆丙种球蛋白病，尿中检测到游离λ链。骨髓活检显示肿瘤性浆细胞间质浸润，同时存在由单一的小淋巴细胞组成的肿瘤性淋巴样细胞局部聚集，偶见核裂。浆细胞免疫表型为IgA λ。患者还存在空肠肿物，活检证实为恶性淋巴瘤，弥漫性小裂细胞型。肿瘤泛B标志物弥漫性阳性。化疗后，IgA λ单克隆蛋白减少，患者病情改善。该病例提示，第二种B细胞肿瘤可能由原始肿瘤克隆转化而来，或者恶性肿瘤在发病时可能是多克隆的。对每种疾病进行明确诊断和分期对于合理治疗很重要。
