Horny H P, Menke D M, Kaiserling E, Steinke B
Abteilung für spezielle Histo- und Zytopathologie, Universität Tübingen.
Dtsch Med Wochenschr. 1995 Dec 15;120(50):1734-8. doi: 10.1055/s-2008-1055535.
A 60-year-old man was found on routine examination to have an enlarged, firm, cervical lymph node. He looked older than his age and his general condition was poor. He had no fever, nocturnal sweating or weight loss. Further examination revealed no hepatosplenomegaly on palpation, but numerous enlarged cervical lymph nodes were palpable.
Histological investigation of a cervical lymph node revealed a marked increase in slightly pleomorphic plasma cells with monotypic expression of IgM-kappa. Multiple myeloma was excluded on the basis of histological and cytological findings in the bone marrow. Serology revealed a mild antibody deficiency syndrome (gamma-globulin 7.8%) with signs of acute inflammation and an increase in alpha 2-globulin. There was no evidence of a monoclonal gammopathy on electrophoresis. A diagnosis of primary nodal plasmacytoma was made.
As the patient was asymptomatic at diagnosis he was not given chemotherapy. There was no evidence of tumour progression at follow-up examination two months later. His progress will be monitored closely.
This patient's history is consistent with the prognosis generally associated with primary nodal plasmacytoma that is much better than that of multiple myeloma.
一名60岁男性在常规检查中发现颈部淋巴结肿大、质地坚硬。他看起来比实际年龄苍老，一般状况较差。他无发热、盗汗或体重减轻。进一步检查发现触诊时无肝脾肿大，但可触及多个肿大的颈部淋巴结。
对一个颈部淋巴结进行组织学检查显示，轻度多形性浆细胞显著增多，IgM-κ呈单型表达。根据骨髓的组织学和细胞学检查结果排除了多发性骨髓瘤。血清学检查显示存在轻度抗体缺乏综合征（γ-球蛋白7.8%），伴有急性炎症迹象和α2-球蛋白升高。电泳检查未发现单克隆丙种球蛋白病的证据。诊断为原发性淋巴结浆细胞瘤。
由于患者诊断时无症状，未给予化疗。两个月后的随访检查未发现肿瘤进展迹象。将密切监测其病情进展。
该患者的病史与原发性淋巴结浆细胞瘤通常的预后相符，其预后远优于多发性骨髓瘤。
